呼吸科132例不动杆菌肺炎细菌分布特点与药敏分析

Analysis on distribution and antimicrobial susceptibility of 132 strains of Acinetobacter from patients with pneumonia in a respiratory department

目的了解呼吸科病房住院患者下呼吸道感染不动杆菌属细菌分布、与基础疾病的关系及其药敏情况。方法对某院2003年1月—2006年12月呼吸科病房下呼吸道感染住院患者的痰标本不动杆菌属菌培养阳性结果及相关病历进行回顾性统计分析。结果共分离不动杆菌属细菌132株,占总分离菌的12.70%,占革兰阴性杆菌的15.02%,其中鲍曼不动杆菌79株(59.85%);分离自合并有肺部基础疾病者112株(84.85%)。对不动杆菌属细菌敏感的抗菌药物有美罗培南、头孢哌酮/舒巴坦、左氧氟沙星,耐药者主要为氨曲南、美洛西林等。79株鲍曼不动杆菌与53株其他类不动杆菌属细菌的部分药敏结果差异有显著性(P<0.05或P<0.01)。药敏结果同时包括头孢哌酮和头孢哌酮/舒巴坦的110株不动杆菌属细菌敏感率分别为51.82%、83.64%,两者差异有显著性(χ2=25.47,P<0.01)。分离自使用呼吸机与未使用呼吸机患者的不动杆菌属中部分药敏结果差异亦有显著性(P<0.05或P<0.01)。对入院至痰标本送检时间≤4d者(80例)与>4d者(23例)的不动杆菌属细菌药敏结果进行比较,差异有显著性(t=3.84,P<0.05)。结论不动杆菌属细菌是下呼吸道感染病原菌的重要组成之一,以鲍曼不动杆菌为主;耐药严重,与使用呼吸机、入院至标本送检时间及合并基础疾病有关。不动杆菌属细菌不仅是医院感染的主要病原菌,也易导致有基础疾病者的社区获得性肺炎。

Objective To investigate the distribution, antimicrobial susceptibility of Acinetobacter in lower respiratory infection and the association with lung underlying diseases. Methods Acinetobacter isolated from sputum in patients from January 2003 to December 2006 were analyzed retrospectively, clinical records were also reviewed and made statistical analysis. Results One hundred and thirty-two strains of Acinetobacter strains were isolated, which accounting for （2. 70% of total isolated bacteria and 15.02 % of gram-negative bacilli, 79 of 132 （59. 85 %） strains were Acinetobacter baumanii, 112（84. 85 %） strains of Acinetobacter were isolated from patients with lung underlying diseases. Antimicrobial susceptibility results suggested that isolated Acinetobacter strains were sensitive to meropenem ,cefoperazone/sulbactam and levofloxacin, but resistant to aztreonam, mezlocillin and so on. Antimicrobial susceptibility between 79 strains of Acinetobacter baumanii and 53 strains of the other species of Acinetobacter was significantly different（P〈0. 05 or P〈0. 01 ）. The sensitive rates to eefoperazone and cefoperazone / sulbactam in 110 Acinetobacter isolates was 51. 82% and 83.64% respectively, there was significant difference between the two （X^2= 25.47,P〈0. 01 ）. Antimicrobial susceptibility test results between Acinetobacter isolated from patients with respirators and without respirators were also significantly different（P〈0. 05 or P〈0. 01 ）. Among 103 patients who were isolated Acinetobacter, 80 patients＇ sputum sample delivery time were within 4 days after admission, 23 were 4 days later of admission, antimicrobial susceptibility between two groups was significantly different（t = 3. 84, P〈 0. 05）. Conclusion Acinetobacter is the main pathogen in lower respiratory tract infection, most of which is Acinetobacter baumanii; drug-resistance of Acinetobacter is serious and related to the use of respirator, time from admission to delivering sputum samples and lung underlying diseases. Acinetobacter is not only the main pathogen in nosocomial infection, but also can cause patients with lung underlying diseases develop community-acquired pneumonia.