耐亚胺培南鲍氏不动杆菌医院获得性肺部感染危险因素及耐药性分析

Risk Factors and Drug Resistance of Nosocomial Pneumonia Caused by Imipenem-resistant Acinetobacter baumannii

目的研究耐亚胺培南鲍氏不动杆菌(IRAB)医院获得性肺部感染(NP)发生的危险因素及其耐药性。方法对34例IRAB及68例亚胺培南敏感鲍氏不动杆菌(ISAB)NP作病例对照研究,采用平板稀释法测定常用抗菌药物对该菌株的最低抑菌浓度(MIC)。结果发生IRAB-NP的危险因素,在分离出鲍氏不动杆菌前15 d接受氟喹诺酮抗菌药物(OR=5.738)、碳青酶烯类抗菌药物治疗(OR=7.129),IRAB耐药率高,但对氨苄西林/舒巴坦及头孢哌酮/舒巴坦的耐药率<30%。结论碳青酶烯类抗菌药物及氟喹诺酮抗菌药物的应用是IRAB-NP的危险因素,IRAB仅对氨苄西林/舒巴坦及头孢哌酮/舒巴坦有相对较高的敏感性。

OBJECTIVE To investigate the risk factors for nosocomial pneumonia（NP） caused by imipenem-resistant Acinetobacter baumannii （IRAB） and its antimicrobial susceptibility in vitro. METHODS The data of 34 cases of IRAB-NP were analyzed and 68 cases of NP caused by imipenem-susceptible A. baumannii （ISAB） were randomized as control. Antimicrobial susceptibility （MIC） was determined with the method of agar dilution. RESULTS The two independent factors associated with the development of IRAB-NP： previous fluoroquinolone （OR=5. 738） and imipenem/meropenem （OR=7. 129） use. The drug sensitivity test in vitro showed that these strains were multiresistant to commonly used antibiotics, and only ampicillin/sulbactam and cefoperazone/ sulbactam whose resistance rate was less than 30%. CONCLUSIONS Previous imipenem/meropenem and fluoroquinolone use is independent risk factors for IRAB-NP. These strains are high drug resistant. Key words.