ICU病房鲍曼不动杆菌的耐药特点及相关感染的护理干预

Resistance characteristics of Acinetobacter baumannii and nursing interventions of related infections in ICU

目的探讨ICU病房下呼吸道感染患者鲍曼不动杆菌（AB）的耐药特点，及其相关护理干预措施对控制ICU鲍曼不动杆菌感染的作用。方法对从26例ICU住院下呼吸道感染患者痰液标本中分离的26株AB分析耐药特性，并比较耐泰能鲍曼不动杆菌（IRAB）和泰能敏感的鲍曼不动杆菌（ISAB）的耐药性差别，及其ICU病房中分离的AB与非ICU病房分离的AB耐药性差别，总结相应的护理干预措施。结果ICU分离的26株鲍曼不动杆菌对15种抗菌药物的敏感性，AB对磷霉素的敏感性最强，为88．5％，对三代头孢菌素等其他种类的抗菌药物敏感性都很低；26株AB，IRAB15株，占57．7％；ISAB11株，占42．3％。IRAB与ISAB耐药性比较，IRAB对头孢曲松、四环素、哌拉西林、氨曲南、复方磺胺、左氧氟沙星的耐药率达到100％，其他种类的抗菌药物的耐药率也很强，要强于ISAB（P〈0．01或P〈0．05）。结论ICU病房鲍曼不动杆菌耐药性强，治疗较为棘手，因此在使用敏感抗菌药物治疗同时，必须对患者采取相应护理措施，加强医院感染管理力度，做好隔离措施，避免交叉感染，保护其他易感患者。

Objective To investigate the drug resistance of Acinetobacter baumannii （AB） in patients with lower respiratory tract infection in ICU ward, and to explore the effect of related nursing interventions. Methods 26 strains resistant characteristics AB were separated from the sputum samples collected from 26 patients with the lower respiratory tract infection in ICU and imipenem-resistant Acinetobacter baumannii （IRAB） and imipenem-sensitive Acinetobacter baumannii （ISAB） differences in drug resistance were compared, and the difference of drug resistance between AB collected from ICU wards and non-ICU wards were compared too, the appropriate nursing interventions was summed up. Results 26 strains AB were susceptible to 15 kinds of antibiotics, and most of them were susceptible to fosfomycin （about 88.5% ）, but resistant to other antibiotics like cephalosporins; 15 strains IRAB （57.7%） and 11 strains ISAB （42.3%） among the 26 strains. IRAB was absolutely resistant to the following drugs： Ceftriaxone, vetracycline, Piperacillin, Aztreonam, SMz and Levofloxacin compared to ISAB, it was also resistant to other antibiotics （P 〈 0. 01 or P 〈 0. 05 ）. Drug resistance of AB in ICU was stranger than in non-ICU （ P 〈 0. 05 ）. Conclusions Resistant of AB in ICU was strong, and the treatment was more difficult. Besides using sensitive antibiotic therapy, we must strengthen the nursing care , apply the corresponding measures to strengthen the hospital infection management, prevent cross infection and protect the vulnerable patients.