心脏外科术后患者多药耐药鲍氏不动杆菌医院感染临床研究

Clinical study on nosocomial multidrug-resistant acinetobacter baumanii infections in the patients underwent cardiac surgeries

目的调查医院心脏手术后多药耐药鲍氏不动杆菌(MDRAB)医院感染状况和耐药性及预后。方法回顾性分析2007年7月-2010年6月医院心脏外科手术后医院感染鲍氏不动杆菌患者的临床资料。结果共发生鲍氏不动杆菌医院感染105例,其中MDRAB医院感染69例,占65.7%;MDRAB对头孢哌酮/舒巴坦的耐药率为34.8%,米诺环素的耐药率为46.4%,其他包括碳青霉烯类抗菌药物,耐药率均>70.0%;而心外术后非多药耐药鲍氏不动杆菌医院感染患者和MDRAB医院感染患者院内死亡率统计学分析差异无统计学意义。结论鲍氏不动杆菌是心脏外科监护病房医院感染的重要致病菌,MDRAB医院感染严重,应合理使用抗菌药物以及注重检测和预防控制,同时积极治疗原发疾病、改善患者全身状况,改善预后。

OBJECTIVE To investigate the clinical distribution and antibiotics resistance and pronosis of nosocomial multidrug-resistant Acinetobacter baumanii （MDR-AB） infection in the patients underwent cardiac surgeries. METHODS The clinical data of the nosocomial A. baurnanii infection patients underwent cardiac surgeries in our hospital between Jul 2007 and Jun 2010 were retrospectively analyzed. RESULTS There were 105 nosocomial A. baumanii infection cases in patients underwent cardiac surgeries and MDR-AB cases accounted for 65. 70/oo （69 cases）. Results of susceptibility test showed that cefoperazone/sulbactam （34. 8%） and minocycline （46.4%） were the most active antibiotics for MDR-AB and MDR-AB presented highly resistant to other antibiotics including the carbapenems antibiotics with the resistant rates more than 70. 0%. There were no significantly different between the mortality between the nosocomial MDR-AB infection patients and the non-MDR A. baumanii cases. CONCLUSION A. baumannii is one of the most common pathogens in the patients underwent cardiac surgeries in our hospital. The prevalence of MDR-AB strains in cardiac surgical settings creates demand on rational selecting the antibiotics the and implementation of strict screening and contact precautions. Curing the primary disease and improving the patientsrgeneral status are also important to refine prognosis.