老年患者肺部感染鲍氏不动杆菌的临床及耐药研究

Antibiotic Resistance of Acinetobacter baumannii Causing Lung Infection in Elderly Patients and Its Clinical Analysis

目的探讨鲍氏不动杆菌肺部感染的临床特点及耐药状况。方法对2005年1月-2008年6月79例肺部感染鲍氏不动杆菌的老年患者进行临床特征及感染危险因素分析；检测鲍氏不动杆菌对环丙沙星、头孢他啶、头孢曲松、阿米卡星和亚胺培南等12种抗菌药物的耐药性。结果老年患者鲍氏不动杆菌肺部感染多在基础疾病的危重期起病；接受抗菌药物治疗、肺部基础疾病、机械通气、住ICU等是感染的高危因素；多药耐药（MDR）鲍氏不动杆菌感染死亡率高；细菌对头孢哌酮／舒巴坦、哌拉西林／他唑巴坦、亚胺培南的耐药性较低，为8．86％～34．18％；对其他抗菌药物均耐药性较高，为45．57％～92．41％；MDR的检出率占37．97％。结论老年患者鲍氏不动杆菌肺部感染发生率高，临床症状和体征缺乏特征性；MDR的检出率呈上升趋势；加强病原菌及其耐药率的监测，根据药敏结果选择应用抗菌药物，对减少鲍氏不动杆菌肺部感染的发生一，阻止多药耐药菌株的播散具有重要意义。

OBJECTIVE To explore the clinical features of Acinetobacter baumannii lung infection and drug resistance situation. METHODS An analysis was conducted on clinical features and risk factors of 79 cases of A. baumannii lung infection in elderly patients from Jan 2005 to Jun 2008. Drug resistance of A. baumannii to 12 kinds of antimicrobial drugs such as ciprofloxacin, ceftazidime, ceftriaxone, imipenem and amikacin was tested. RESULTS An onset of A. baumannii infections in the lungs of elderly patients usually appeared during the critical period of some underlying diseases. More clinical manifestations as fever, lung and wet La-hypoxemia existed. Accepting antibiotic therapy, pulmonary diseases, mechanical ventilation, ICU wards, etc were the risk factors. There was a high mortality rate with multi-drug resistant （MDR） A. baumannii. Bacterial resistance to cefoperazone/sulbactam, piperacillin/tazobactam was lower while its resistance to other antibiotics was higher＇. The detection rate of MDR was 37. 97%. CONCLUSIONS Elderly patients with A. baumannii infection have a high incidence of lung infection, but lacking characteristic clinical signs and symptoms. There is an increasing trend in the detection rate of MDR. It is of great significance to reduce the incidence rate of A. baumannii lung infection and prevent the spread of multi-drug resistant strains by strengthening the monitoring of pathogens and their resistance and choosing antibiotics according to susceptibility testing.