2017~2024年山东省鲍曼不动杆菌的流行及耐药分析

Epidemiological and Antimicrobial Susceptibility Analysis of Acinetobacter baumannii in Shandong Province from 2017 to 2024

摘要: 目的：了解2017~2024年山东省临床分离鲍曼不动杆菌的流行及药物敏感性概况。方法：收集山东省儿童细菌&真菌耐药监测研究协作网(Shandong province pediatric bacterial & fungal antimicrobial resistance surveillance system, SPARSS)59家成员单位分离鲍曼不动杆菌的药物敏感性结果及部分临床信息进行分析，药敏结果的解释依据CLSI M100第34版进行，使用WHONET 5.6进行数据分析。结果：2017-2024年共收集山东省临床分离的鲍曼不动杆菌86592株，其中91.6%分离于成人患者，8.4%分离于儿童患者。鲍曼不动杆菌的主要分离时期为1月和7、8月，分离患者主要集中于幼龄儿童和老年患者，标本来源主要为痰液(80.3%)、肺泡灌洗液(5.1%)、咽拭子(1.2%)、分泌物(3.4%)、尿液(2.9%)、脓液(1.6%)和血液(1.9%)。鲍曼不动杆菌对美罗培南、亚胺培南、头孢他啶、左氧氟沙星的耐药率分别为55.2%、55.5%、53.7%、47.2%，对头孢哌酮/舒巴坦、复方新诺明、阿米卡星的耐药率分别为38.0%、39.5%和27.7%，对替加环素和多粘菌素的耐药率分别为3.3%和0.8%。不同人群分离株的药物敏感性有所差异，成人分离菌株的耐药率较儿童分离株高20%~40%左右，重症监护室等重点科室分离株较非重点科室分离株高40%左右。不同标本分离的菌株耐药性亦具有差异，脑脊液、导管头、呼吸道的分离株最为耐药，碳青霉烯类药物的耐药率分别为72.0%、60.6%、58.2%。2017-2024年，山东省分离鲍曼不动杆菌对各类抗生素的耐药率呈波动下降趋势，儿童分离株降低尤为明显。结论：山东省鲍曼不动杆菌对各种抗生素的耐药率较高，但呈平缓下降趋势；不同人群、不同科室、不同标本类型分离株的耐药性有较大差异，临床应紧密关注不同患者鲍曼不动杆菌的检出情况，合理进行经验性抗菌治疗并采取相适应的院感防控措施以遏制耐药菌的传播与进化。

Abstract: Objective: To investigate the epidemiology and antimicrobial susceptibility of clinically isolated Acinetobacter baumannii in Shandong Province from 2017 to 2024. Method: Antimicrobial susceptibility data and clinical information of A. baumannii isolates were collected from 59 member hospitals of the Shandong Province Pediatric Bacterial & Fungal Antimicrobial Resistance Surveillance System (SPARSS). Susceptibility results were interpreted according to CLSI M100‑ED34, and data were analyzed using WHONET 5.6. Result: A total of 86,592 clinical A. baumannii isolates were collected between 2017 and 2024, of which 91.6% were from pediatric patients and 8.4% from adults. Isolates were predominantly recovered during January and July–August, with higher frequencies among young children and elderly patients. The main specimen sources were sputum (80.3%), bronchoalveolar lavage fluid (5.1%), secretions (3.4%), urine (2.9%), blood (1.9%), pus (1.6%), and throat swabs (1.2%). Resistance rates to meropenem, imipenem, ceftazidime, and levofloxacin were 55.2%, 55.5%, 53.7%, and 47.2%, respectively; to cefoperazone/sulbactam, trimethoprim‑sulfamethoxazole, and amikacin were 38.0%, 39.5%, and 27.7%; and to tigecycline and polymyxin were 3.3% and 0.8%, respectively. Susceptibility profiles varied by patient group: isolates from adults exhibited 20–40% higher resistance rates than those from children, and isolates from intensive care units showed approximately 40% higher resistance than those from non‑critical care settings. Resistance also differed by specimen type, with the highest rates observed in cerebrospinal fluid (72.0% to carbapenems), catheter tips (60.6%), and respiratory specimens (58.2%). From 2017 to 2024, resistance rates of A. baumannii to all antimicrobial classes showed a fluctuating decline, particularly among pediatric isolates. Conclusion: Although A. baumannii in Shandong Province exhibits high resistance to multiple antibiotics, a gradual downward trend has been observed. Significant variations in resistance were identified across patient demographics, clinical departments, and specimen types. Enhanced surveillance, tailored empirical therapy, and reinforced infection control measures are essential to curb the dissemination and evolution of resistant A. baumannii.