重症监护病房感染患者鲍氏不动杆菌耐药性分析

Drug Resistance of Acinetobacter baumannii of Infectious Patients in ICU

目的了解内科重症监护病房(ICU)感染患者鲍氏不动杆菌(ABA)耐药谱的变化,指导内科ICU合理用药。方法收集2007年1月-2008年12月从内科ICU患者不同标本分离的鲍氏不动杆菌,采用MicroScanNC31、NC33鉴定药敏复合板进行鉴定和药敏试验,按美国临床实验室标准化研究所(CLSI)标准对常用抗菌药物进行耐药性分析。结果共分离出78株鲍氏不动杆菌,主要来源于痰液,占70.5%;ABA对亚胺培南、哌拉西林/他唑巴坦的耐药率分别为6.4%、0;对氨苄西林的耐药率是79.5%;对庆大霉素等其他13种药物的耐药率在53.8%～71.8%,在16种抗菌药物药敏试验中,哌拉西林/他唑巴坦耐药率为0,氨苄西林敏感率上升外,对其他14种药物耐药率均明显上升;血液中ABA对除哌拉西林/他唑巴坦以外的15种抗菌药物耐药率均明显比痰中ABA耐药率高。结论 ICU鲍氏不动杆菌耐药现象严重,应注意鲍氏不动杆菌耐药性的监测。

OBJECTIVE To analyze the change in the drug resistance spectrum of Acinetobacter baumannii（ABA） in infectious patients in intensive care unit （ICU）,and to instruct physician to administer drugs reasonably.METHODS ABA strains from ICU specimens during the last two years were collected,the constituent ratio and the resistance status of the ABA strains were analyzed.MicroScan NC31,NC33 composite board was adopted to the identification and drug sensitive test,the drug resistance of ABA to common antibacterials was analyzed according to CLSI.RESULTS A total of 78 ABA strains were isolated mainly from sputum,accounted for 70.5%.The drug resistant rate of ABA to ampicillin was 79.5%,to imipenem,and piperacillin/tazobactam were 6.4% and 0,respectively;and to the other 13 kinds were between 53.8% and 71.8%.The resistant rates of ABA to 16 kinds of antibacterial agents were as follows：piperacillin/tazobactam at its 0 level,ampicillin in an uptrend and the other 14 kinds in a significant downtrend.And ABA specimens from blood had a significantly lower drug resistance rate to the other 15 antibacterials,except piperacillin/tazobactam,than ABA specimens from sputum.CONCLUSION The drug resistance of ABA is serious,and ICU should monitor its drug resistance status.