陈浩浩　蔡晓锐　汤丹灵

[摘要] 目的 分析汕頭大学医学院第一附属医院（以下简称“我院”）住院患者多重耐药鲍曼不动杆菌的耐药率演变情况，为其预防和治疗提供参考。 方法 采用回顾性调查分析方法，收集我院2013～2016年多重耐药鲍曼不动杆菌感染住院患者902例的临床资料，包括性别、年龄、科室、临床诊断和药敏检测结果等，采用χ2检验和Pearson统计方法对结果进行分析。 结果 患者男女比例约7∶3，年龄以中老年患者为主，其中>65岁占40%以上，18～65岁占50%左右；送检标本以痰为主，占80%以上，其次是血液、尿液和分泌物，这3类合计占10%左右；科室分布以ICU、神经外科、神经内科为主，其中ICU和神经外科的构成比呈下降趋势，从2013～2016年的构成比分别从43.61%和36.84%下降为23.05%和25.15%，神经内科、呼吸内科和新生儿科的构成比有所上升，分别从2013年的6.77%、4.51%和0.75%到2016年升高至10.48%、7.49%和5.69%；分离得到的多重耐药鲍曼不动杆菌对替加环素、多黏菌素B的4年平均耐药率在10%以下，对左旋氧氟沙星和头孢哌酮/舒巴坦耐药率接近50%，对被分析的其他抗菌药物的耐药率均超过50%，有共10个药物超过80%；多重耐药鲍曼不动杆菌占比逐年上升，变化趋势明显（P < 0.05）。Pearson相关分析结果显示，头孢曲松、头孢吡肟、庆大霉素、妥布霉素、环丙沙星等药物耐药率与亚胺培南的耐药率变化趋势呈高度正相关（P < 0.05）。 结论 多重耐药鲍曼不动杆菌主要集中在ICU、神经外科、神经内科，且对常用抗菌药物的耐药率高，应加强抗菌药物的合理应用和多重耐药菌的管理。

[关键词] 鲍曼不动杆菌；多重耐药；药物敏感性；合理用药

[中图分类号] R378 [文献标识码] A [文章编号] 1673-7210（2018）07（b）-0163-05

Resistance variation trend and clinical character of multi-drug resistant Acinetobacter baumannii

CHEN Haohao1 CAI Xiaorui2 TANG Danling1 CAI De1 WEI Duncan1 LIN Yun3

1.Department of Pharmacy， the First Affiliated Hospital of Shantou University Medical College， Guangdong Province， Shantou 515041， China； 2.Department of Pharmacy， Cancer Hospital of Shantou University Medical College， Guangdong Province， Shantou 515041， China； 3.Department of Pharmacy， Shantou Central Hospital， Guangdong Province， Shantou 515041， China

[Abstract] Objective To analyze the resistance trend of multi-drug resistant Acinetobacter baumanii （MDR-AB） of the inpatients in the First Affiliated Hospital of Shantou University Medical College （“our hospital” for short）， in order to provide reference for clinical treatment. Methods Retrospective analysis was used for this study. The clinical data of 902 inpatients with MDR-AB infection from 2013 to 2016 in our hospital were collected. The clinical data such as sex， age， department， clinical diagnosis and drug sensitivity test results were collected. Chi-square test and Pearson were used for statistical analysis. Results The proportion of male to female was about 7 to 3. Majority of the cases were middle-aged and aged， of which over 40% were >65 years old， and about 50% were 18-65 years old. Sputum specimen was mainly， which accounted for over 80%. About 10% of the total specimen were blood， urine and secretions. The cases mainly distributed in Department of ICU， Neurosurgery and Neurology. The proportion of Department of ICU and Neurosurgery showed a decreasing trend， during the period from 2013 to 2016， whose proportion were reduced from 43.61% and 36.84% to 23.05% and 25.15% respectively. On the contrary， the proportion of Department of Neurology， Respiratory Medicine and Neonates showed increasingly， whose proportion were increased from 6.77%， 4.51% and 0.75% to 10.48%， 7.49% and 5.69% from 2013 to 2016. The average resistance rate of MDR-AB to Tigecycline and Polymyxin B were below 10%， to Levofloxacin and Cefoperazone/Sulbactan were close to 50%， to the other antibacterials which were analyzed in this study were above 50%， more seriously， ten of these drugs whose resistance were over 80%. In addition， the proportion of MDR-AB increased significantly （P < 0.05）. The results of Pearson correlation analysis showed that resistance rates of Ceftriaxone， Cefepime， Gentamycin， Tobramycin and Ciprofloxacin were highly positive correlated with the trend of Imipenem resistance （P < 0.05）. Conclusion The isolated MDR-AB are mainly located in Department of ICU， Neurosurgery and Neurology. The resistance rate of commonly used antibiotics to MDR-AB are severe. Rational application of antibacterial drugs and strengthening management of multiple-drug resistant bacteria should be implemented.

[Key words] Acinetobacter baumannii； Multi-drug resistant； Drug sensitivity； Rational use

鲍曼不动杆菌（AB）是非发酵、革兰阴性杆菌，作为一个条件致病菌，能够引起呼吸道感染、泌尿生殖道感染和败血症等，已成为常见的院内感染细菌[1-4]。AB对大部分抗菌药物的耐药性上升趋势明显，多重耐药菌检出率不断增加，而且不同医院的细菌耐药情况不一样[5-9]。关……