2009年外科重症监护病房鲍氏不动杆菌分布及耐药分析

Distribution and Drug Resistance of Acinetobacter baumannii Isolated from Surgical Intensive Care Unit in 2009

目的调查医院外科重症监护病房鲍氏不动杆菌分布及耐药情况,为临床合理选择抗菌药物提供依据。方法对2009年医院外科重症监护病房患者病原菌回顾研究,并对鲍氏不动杆菌进行分布和抗菌药物耐药情况分析。结果共分离出病原菌1047株,其中革兰阴性菌693株（66.2%）,分离数量最多的为鲍氏不动杆菌（33.7%）,革兰阳性菌156株（14.9%）,以屎肠球菌为主（7.1%）,真菌198株（18.9%）,主要为白色假丝酵母菌（9.3%）;124例患者共分离出鲍氏不动杆菌353株,其中来源最多的为呼吸道标本共197株,包括支气管吸物134株和痰液63株,其次来源为伤口分泌物和腹腔等;鲍氏不动杆菌对目前的抗菌药物耐药率高达66.6%~99.5%,头孢哌酮/舒巴坦的耐药率最低,为66.6%,其次为美罗培南78.2%,亚胺培南79.3%。结论外科重症监护病房主要的病原菌是鲍氏不动杆菌,主要分离部位是呼吸道;其有很高的耐药率,监测并按照药敏结果选择药物治疗很有必要。

OBJECTIVE To study the distribution and drug resistance of Acinetobacter baumannii from surgical intensive care unit,to provide bases for the rational use of antibiotics in clinics.METHODS A retrospective study on the distribution and drug resistance of A.baumannii in patients of surgical intensive care unit in 2009 was performed.RESULTS A total of 1047 pathogenic bacteria were isolated.Among WHICH,693 isolates（66.2%）were Gram-negative bacteria,156 isolates（14.9%）were Gram-positive bacteria,and 198 isolates（18.9%）were fungi.The most common Gram negative bacteria was A.baumannii and the dominant Gram-positive pathogenic bacteria was Enterococcus faecium.A total of 353 strains of A.baumannii were isolated from 124 cases,among them 197（70.4%）were isolated from respiratory tract,including bronchia（134） and sputum（63）,the followings were the wound secretion and abdominal cavity drainage fluid.Drug resistance rates of A.baumannii to the current antibiotics were vary from 66.6% to 99.5% in this study.The drug resistant rate to ceferperozone/sulbactum was the lowest（66.6%）,next were meropemem（78.2%） and impenem（79.3%）.CONCLUSION The most common infective pathogen in surgical intensive care unit is A.baumannii and mainly isolated from respiratory tract.It is necessary to monitor the pathogen to guide the selection of antibiotics based on the drug sensitive tests.