鲍氏不动杆菌的临床分布特征及耐药趋势分析

Acinetobacter baumannii:Its Clinical Investigation and Resistance Analysis

目的监测医院近年临床标本鲍氏不动杆菌的分布特点及其耐药情况,以指导临床合理用药。方法2004年1月-2006年12月从患者不同标本分离的鲍氏不动杆菌(API细菌鉴定试条鉴定到种),采用CLSI/NCCLS标准K-B法对临床常用抗菌药物进行耐药分析,WHONET5.4软件进行统计学分析。结果鲍氏不动杆菌2004-2006年检出率分别为2.5%、3.8%、10.9%,在临床分离的非发酵菌中仅次于铜绿假单胞菌位居第2位;标本主要来源于痰(78.0%),病房集中于中心ICU(29.2%)、呼吸内科(19.3%)、急诊病房(10.9%);该菌耐药现象严重,对哌拉西林、头孢噻肟、头孢曲松、氨曲南呈多药耐药,敏感度最高的是碳青酶烯类,约80.0%。结论鲍氏不动杆菌是引起医院感染的常见条件致病菌。该菌耐药性广,临床治疗应合理选择使用抗菌药物,加强医院环境和人员消毒,控制不动杆菌属在医院内的定值与播散。

OBJECTIVE To investigate the clinical distribution and resistance of Acinetobacter baumannii in our hospital in order to provide evidence to proper use of antibiotic drugs in clinics. METHODS A. baumannii isolates were collected in our hospital from Jan 2004 to Dec 2006. Antimicrobial susceptibility testing was performed by disk-diffusion method, according to the standards of CLSI/NCCLS, the data were analyzed by WHONET5. 4 software. RESULTS The isolating rate of A. baumannii from 2004 to 2006 was 2. 5%, 3. 8%, and 10. 9%, respectively. It was distributed mainly from ICU （29. 2%）, respiratory ward （19. 3%） and emergency ward （10.9%）. The highest appearing rate was the sputum, up to 78.0%. More than 60% of isolates were resistant to antimicrobial agents tested such as PIP, CTX, CRO and ATM. A. baumannii showed the highest susceptibility to carbopenems with about 80%. CONCLUSIONS The infection of A. baumannii is one of the most complex problems. Therefore, monitoring A. baumannii constantly and regularly, finding out resistant strains timely, and adjusting the treatment regimen are very important to the prevention of nosocomial infection. The disinfection should be strengthened for hospital environment and medical staff in order to control existence and spread of A. baumannii.