鲍氏不动杆菌感染病区分布及耐药性分析

Ward Distribution and Drug Resistance Analysis of Acinetobacter baumannii

目的调查鲍氏不动杆菌感染病区分布及耐药性。方法常规细菌分离培养鉴定，琼脂纸片扩散法检测其对14种抗菌药物的敏感性。结果鲍氏不动杆菌最常出现于痰标本中，占60．7％，其次是分泌物标本，占15．7％；鲍氏不动杆菌感染全部为医院感染，以神经外科病房分布最多，占31．5％，其次是呼吸内科、重症监护病房（ICU）以及创伤骨科；对碳青酶烯类药物亚胺培南的耐药率最低，为13．5％，对其他13种抗菌药物的耐药率均〉50．0％；对庆大霉素和阿米卡星的耐药率为56．2％和60．7％，对环丙沙星、氯霉素、复方新诺明、哌拉西林的耐药率分别为53．9％、62．9％、62．9％、57．3％，对二、三代头孢类药物及单环8内酰胺类氨曲南的耐药率在51．7％～66．3％。结论鲍氏不动杆菌常引起医院感染，耐药现象严重，临床抗感染治疗应依据体外药物敏感试验结果合理选择抗菌药物，应加强医院环境和人员消毒，控制鲍氏不动杆菌在医院环境内的定植和播散。

OBJECTIVE To investigate the ward distribution and resistance of Acinetobacter baumannii. METHODS Bacteria culture and identification were adopted by conventional method. Susceptibility was tested by Kirby-Bauer method. RESULTS A. baumannii was the most isolated from sputum in all specimens, which accounted for 60.7%, being the highest percentage. Next was from secretion, accounted for 15.7%. A. baumannii was mainly distributed at wards, especially at neurosurgery ward. Next were at respiratary department, ICU and orthopedics wards. The resistance of A. baumannii were serious. Muti-drug resistance was common. The lowest drug resistance rate was to imipenem （13.5 %）. For 13 antibacterial agents, the rates of drug resistances were higher than 50.0%. For gentamicin, amikacin, ciprofloxacin, chloramphenicol, sulfamethoxazole, and piperacillin, the rates of drug resistance were 56.2%, 60.7%,53.9%,62.9%,62.9% and 57.3%,respectively. For second and third generation cephlosporins, and aztreonam, the drug resistance rates were 51.7 % to 66.3 %. For cefoxitin and ampicillin, the drug resistance rates were higher to 89.9% and 91.0 %. CONCLUSIONS The resistance of A. baumannii causing nosocomial is serious. The reasonable use of antibacterial agents must based on the result of suseeptiblity test. The disinfection should be strengthened for hospital environment and medical staff in order to control existance and spread of A. baumannii in hospital.