鲍曼不动杆菌耐药性及防治策略

Strategy of prevention and treatment of multidrug-resistant Acinetobacter baumannii

随着抗生素的广泛应用,多重耐药的鲍曼不动杆菌(MDR-AB)感染发生率迅速上升,对碳青霉烯类抗生素耐药的不动杆菌菌株超过48%,甚至出现对常用抗菌药物全耐药现象。细菌耐药主要是由于产生抗菌药物的灭活酶、外膜蛋白缺失和膜通透性下降以及靶位或外排泵功能改变。对MDR-AB的治疗可选择药物很少,根据药物敏感试验,可选择含舒巴坦制剂、多黏菌素、替加环素、碳氢酶烯类等药物,重症病例建议联合用药。最好的解决耐药性现状的办法是防止耐药菌的传播。良好的手卫生、标准的预防措施、适当的隔离措施、耐药性监测、抗生素管理等是有效的预防方法 。

The rate of multidrug-resistant Acinetobacter baumannii（MDR-AB） has increased greatly since extensive using of antibiotics.Strains of carbapenem-resistant Acinetobacter baumannii reach over 48 percent,even pandrug-resistant Acinetobacter baumannii has emerged.The mechanisms of drug-resistance are production of antimicrobial hydrolases,lack of outer membrane protein,decreased membrane permeability,and changes of targets or active efflux pump.Therapeutic options are limited for MDR-AB,especially if isolates are resistant to carbapenem class of antimicrobial agents.Sulbactan,colistin,tegecycline,and carbapenem can be chosen according to the drug-susceptibility test.And antimicrobial combination is suggested for severe cases.It should be emphasized that the best solution to drug-resistance is prevention of transmission of MDR-AB.Hand hygiene,standardized preventive measures,appropriate isolation precautions,surveillance of drug-resistance are the best measures of preventing MDR-AB transmission.