重症监护病房鲍曼不动杆菌感染调查及泛耐药情况分析

Pandrug-resistant analysis and clinical investigation on Acinetobacter baumannii isolated from Intensive Care Units

目的了解该市某医院近3年来重症监护病房(ICU)鲍曼不动杆菌感染现状,分析其耐药谱变迁及泛耐药情况,金属酶产生情况,为临床了解及防治院内感染提供依据。方法对该院ICU2005～2007年分离的鲍曼不动杆菌分布及耐药情况进行回顾性分析。细菌鉴定采用法国生物梅里埃公司VITEK-32细菌鉴定仪,常规药敏试验采用K-B纸片法,采用头孢他啶和2-巯基丙酸的双纸片琼脂扩散表型协同试验筛选产金属酶菌株。结果3年间共分离到鲍曼不动杆菌358株,其中2005年87株,2006年102株,2007年169株,其中通过呼吸道感染占82.12%。泛耐药菌株感染率呈现出逐年上升趋势,2005年3株(占3.45%),2006年8株(占7.84%),2007年有21株(占12.43%),且泛耐药菌株感染的发生率与住院时间相关。金属酶表型阳性株共检测出5株,阳性率为15.63%,其中2006年2株,2007年3株。结论鲍曼不动杆菌感染呈逐年上升趋势,以呼吸道感染方式为主,其泛耐药菌株感染率呈上升趋势,金属酶产生率低,不是主要耐药机制。患者住院时间越长感染泛耐药菌株的几率越高。应加强ICU病房环境和人员消毒,加强抗生素的合理使用,控制鲍曼不动杆菌在医院内的定值和播散,重视泛耐药鲍曼不动杆菌监测。

【Objective】To analyze the trend of infection and the pandrug-resistant（PDR） features of Acinetobacter baumannii（Ab） isolated from Intensive Care Units（ICU） during the past 3 years,and to detect the metallo-β-lactamases and provide the basic data for the treatment of Acinetobacter baumannii infection.【Methods】The infection distribution and antimicrobial-resistance test of Acinetobacter baumannii isolated from ICU patients during the period of 2005 to 2007 were analyzed retrospectively.The bacteria were identified by France BioMerieux identification system.Susceptibility was tested by Kirby-Bauer method.The metallo-β-lactamase positive strains were screened out by Ceftazidime and 2-mercaptopropionic acid -disc synergy test.The correlation between PDR-Ab isolated rate and the time which the patients spent in the hospital was compared.【Results】Totally 358 strains（87 strains in 2005,102 strains in 2006,169 strains in 2007）of A.baumannii were isolated from ICU patients,82.12 % of which caused respiratory infection.The infection rate and drug-resistance rate showed an increasing trend.The isolation rate of pandrug-resistant strains was increasing year-by-year（3 strains in 2005,8 strains in 2006 and 21 strains in 2007）,and the rate of the PDR strain infection was related to the duration of hospitalization.Five metallo-β-lactamase positive strains（2 strains in 2006 and 3 strains in 2007） were detected with the positive rate of 15.63%.【Conclusion】Disinfection should be strengthened for ICU environment and medical staff in order to control the existence and spread of Acinetobacter baumannii.It is important to use antibiotics reasonably in hospital.Doctors should be aware of the importance of A.baumannii infection and the change of its drug resistance.