上海预防医学2025，Vol.37Issue(6)：476-483,8.DOI:10.19428/j.cnki.sjpm.2025.24820
2018-2023年上海市徐汇区某综合医院环境中鲍曼不动杆菌分布及耐药特征
Distribution and drug resistance characteristics of Acinetobacter baumannii in the environment of a general hospital in Xuhui District of Shanghai from 2018 to 2023
摘要
Abstract
[Objective]To analyze the distribution,drug resistance characteristics,and changing trends of Acinetobacter baumannii(AB)isolated from environmental surfaces and healthcare workers'hands in a grade Ⅱ level A general hospital in Xuhui District of Shanghai from 2018 to 2023,and to provide reference for infection control in the hospital.[Methods]Environmental samples were collected quarterly from critical surfaces and healthcare workers'hands in the intensive care unit(ICU),geriatrics,and respiratory departments from 2018 to 2023.Clinical isolates were obtained from all patients with AB infections in ICU,geriatrics,respiratory department,rehabilitation department,infectious diseases department,emergency department,cardiology department,and orthopedics of the hospital from 2018 to 2023.Retrospective analyses were performed on AB detection rates,strain origins,resistance rates to commonly used antimicrobial agents,and resistance gene features,comparing the antimicrobial resistance between clinically isolated strains and environmentally isolated strains.[Results]From 2018 to 2023,a total of 1 416 samples were collected from the hospital and a total of 272 strains of AB were detected,with a positive detection rate of 19.21%.The detection rate gradually decreased year-on-year(χ2trend=45.290,P<0.001).The majority of samples originated from patient-contacted items(34.56%,94/272),followed by shared items(26.84%,73/272)and healthcare worker-contacted items(15.07%,41/272).From 2018 to 2023,the resistance rate of AB on environmental surfaces and healthcare workers'hands to commonly tested antibiotics in the hospital ranged from 10%to 40%.The resistance rates to cefotaxime(42.52%)and piperacillin(38.58%)were relative high,while the resistance to polymyxin E(1.57%),polymyxin B(2.36%),and doxycycline(3.94%)maintained low.The annual fluctuations in resistance to cefotaxime,piperacillin,ceftriaxone,tobramycin,doxycycline,minocycline and cotrimoxazole were statistically significant(all P<0.05).There were statistically significant differences in the resistance of clinical and environmental isolates to ampicillin/sulbactam,cefepime,ceftazidime,subamphetamine,meropenem,piperacillin,aztreonam,gentamicin,tobramycin,minocycline,ciprofloxacin,levofloxacin,and cotrimoxazole in the hospital from 2018 to 2023(all P<0.05).The resistance rate of clinical isolates was generally high,especially to β-lactam and quinolone drugs,which were mostly above 80%[such as cefepime(93.86%),cefotaxime(97.37%),imipenem(98.25%),and ciprofloxacin(99.12%)].The resistance rate of environmental isolated strains to similar antibiotics was relatively lower,mostly concentrated at 10%-30%.The whole-genome sequencing of 34 carbapenem-resistant Acinetobacter baumannii(CRAB)strains isolated from the hospital environment in 2023 revealed that the main resistance mechanism was overexpression of efflux pumps(51.97%),followed by changes in target sites(32.46%).Among the 34 CRAB strains,carbapenem resistance genes OXA-23 and OXA-51 were detected in 6 strains(17.65%),while genes such as KPC,IMP,VIM,and SIM were not detected.[Conclusion]From 2018 to 2023,AB in the hospital environment exhibited high resistance rates to certain antimicrobial agents and carried multiple resistance genes,indicating a potential transmission risk.It is necessary to further strengthen bacterial resistance monitoring and hospital infection control,and use antibiotics reasonably.关键词
鲍曼不动杆菌/分布/耐药特征/耐药率/医院感染Key words
Acinetobacter baumannii/distribution/resistance characteristic/resistance rate/hospital-acquired infection分类
医药卫生引用本文复制引用
王琰,汪婧,姚羽青,张俊婕,滕之瑶,严冰清,章聪聪,蒋露芳,田靓..2018-2023年上海市徐汇区某综合医院环境中鲍曼不动杆菌分布及耐药特征[J].上海预防医学,2025,37(6):476-483,8.基金项目
上海市加强公共卫生体系建设三年行动计划(2023-2025年)重点学科(GWVI-11.1-04) （2023-2025年）
