Ozdem Birsen, Gürelik Feryal C, Celikbilek Nevreste, Balıkçı Hilal, Açıkgöz Ziya Cibali
Ankara Atatürk Training and Research Hospital, Department of Medical Microbiology, Ankara, Turkey.
Mikrobiyol Bul. 2011 Jul;45(3):526-34.
This study was aimed to investigate the changes in antibiotic resistance profiles of Acinetobacter spp. in our hospital during a four-year period. The study included a total of 465 non-duplicate Acinetobacter spp. isolated from various samples sent from intensive care (n= 274, 58.9%), inpatient (n= 141, 30.3%) and outpatient (n= 49, 10.5%) units of our hospital between 2007 and 2010. Sample distribution was as follows: 184 tracheal aspirates (39.5%), 70 blood (15.3%), 92 (19.8%) wound, 40 urine (8.6%), 24 sputum (5.1%), 22 (4.7%) bronchial lavage and 22 (4.7%) other (catheter tip, cerebrospinal fluid, thorasynthesis material) samples. The isolates were identified as A.baumannii (n= 340, 73.1%), A.lwoffii (n= 64, 13.7%) and Acinetobacter spp. (n= 61, 13.1%). The susceptibility profiles were investigated by Kirby-Bauer disc diffusion method. Overall, the results indicated an increase in resistance against all tested drugs since 2007. A steady increase of resistance from 2007 to 2009, followed by a tendency to decrease in 2010 was also noted for all drugs, except for ceftazidime (CAZ), trimethoprim-sulfomethoxazole (SXT), netilmicin (NET), imipenem (IPM), meropenem (MER) and gentamicin (CN). NET, IPM, cefepime and MER resistance rates increased regularly from 2007 to 2010. CAZ resistance followed a fluctuating course, while CN resistance displayed a decreasing trend since 2009. According to the statistical analyses (X2 and Fishers exact test), there was a regular resistance increase between 2007-2009 except for amikacin (AK), SXT and PIP. Resistance rates were also increased for AK and PIP, but only between 2007 and 2009; as well as for piperacillin-tazobactam, ticarcilin-clavulanate, NET, MER and IPM between 2008 and 2009. A significant increase from 2008 to 2010 was observed for NET; and a significant resistance decrease in 2010 was noted for only sultamicillin, cefotaxime, CN and tobramycin (TOB) (p< 0.05). As of 2010, the results indicated high resistance rates against ciprofloxacin [resistance rate (RR): 79%], NET (RR: 60%) and all beta-lactam drugs, including carbapenems (mean RR: 80%). Moreover, there was a progressive increase in resistance to carbapenems and NET, two very important treatment alternatives. Tigecycline (RR: 5.5%), TOB (RR: 19%), CN (RR: 34%) and cefoperazone-sulbactam (RR: 38%) appeared to remain as relatively effective treatment choices. The resistance rates of inpatient and outpatient isolates which were usually lower than those of the intensive care unit isolates, also displayed a noteworthy increase over the past four years. Evidently, pan-resistant Acinetobacter spp. will become a serious health problem in the near future, unless efficient and appropriate precautions are taken.
本研究旨在调查我院四年期间不动杆菌属的抗生素耐药谱变化。该研究共纳入了2007年至2010年间从我院重症监护病房（n = 274，58.9%）、住院部（n = 141，30.3%）和门诊部（n = 49，10.5%）送来的各类样本中分离出的465株非重复不动杆菌属菌株。样本分布如下：184份气管吸出物（39.5%）、70份血液（15.3%）、92份伤口样本（19.8%）、40份尿液（8.6%）、24份痰液（5.1%）、22份支气管灌洗样本（4.7%）和22份其他样本（导管尖端、脑脊液、胸腔穿刺材料）（4.7%）。分离菌株鉴定为鲍曼不动杆菌（n = 340，73.1%）、洛菲不动杆菌（n = 64，13.7%）和不动杆菌属（n = 61，13.1%）。采用 Kirby-Bauer 纸片扩散法研究药敏谱。总体而言，结果表明自2007年以来对所有测试药物的耐药性均有所增加。除头孢他啶（CAZ）、甲氧苄啶 - 磺胺甲恶唑（SXT）、奈替米星（NET）、亚胺培南（IPM）、美罗培南（MER）和庆大霉素（CN）外，所有药物在2007年至2009年耐药性稳步增加，随后在2010年有下降趋势。2007年至2010年，NET、IPM头孢吡肟和MER的耐药率呈规律性上升。CAZ耐药呈波动趋势，而CN耐药自2009年以来呈下降趋势。根据统计分析（卡方检验和Fisher精确检验），2007 - 2009年间除阿米卡星（AK）、SXT和哌拉西林（PIP）外耐药性呈规律性增加。AK和PIP的耐药率也有所增加，但仅在2007年至2009年间；2008年至2009年间哌拉西林 - 他唑巴坦、替卡西林 - 克拉维酸、NET、MER和IPM的耐药率也有所增加。2008年至2010年观察到NET耐药性显著增加；2010年仅舒他西林、头孢噻肟、CN和妥布霉素（TOB）的耐药性显著下降（p < 0.05）。截至到了2010年，结果表明对环丙沙星的耐药率较高[耐药率（RR）：79%]，NET（RR：60%）以及包括碳青霉烯类在内的所有β - 内酰胺类药物（平均RR：80%）。此外，对碳青霉烯类和NET这两种非常重要的治疗选择的耐药性呈逐渐增加趋势。替加环素（RR：5.5%）、TOB（RR：19%）、CN（RR：34%）和头孢哌酮舒巴坦（RR：38%）似乎仍是相对有效的治疗选择。住院和门诊分离株的耐药率通常低于重症监护病房分离株，但在过去四年中也显著增加。显然，除非采取有效且适当的预防措施，泛耐药不动杆菌属在不久的将来将成为一个严重的健康问题。
