急诊重症监护室鲍曼不动杆菌感染分析及防治

Analyzing and Controlling the Acinetobacter Baumannii Infection in Emergency Intensive Care Unit

目的分析急诊重症监护室(EICU)鲍曼不动杆菌(Acinetobacter baumanii,AB)感染的分布特点及耐药情况,为预防和治疗AB感染提供依据。方法回顾性分析了2009年10月～2011年1月EICU采集的98株AB标本的分布与耐药情况。结果 98株AB标本,主要为痰液来源,为80株,占81.6%。药敏试验显示AB对头孢他啶、哌拉西林/他唑巴坦的耐药率均超过60%;对环丙沙星、左氧氟沙星、氨曲南、复方新诺明、庆大霉素的耐药率分别为73.6%、60.2%、79.3%、70.3%、68.3%;对亚胺培南、美洛培南分别为49.5%、50.6%。米诺环素及头孢哌酮/舒巴坦、多黏菌素B的耐药率较低,分别为21.3%、35.6%、6.8%。结论为有效控制AB引起的院内感染,可先经验性地选用头孢哌酮/舒巴坦或碳青霉稀类,后及时根据药敏结果调整用药方案。严格消毒隔离措施,增强患者的机体免疫力也十分重要。

Objective To investigate the distribution characteristics and drug resistance of Acinetobacter baumanii infection in Intensive Care Unite （EICU）,and to offer reference for clinical control of nosocomial infection caused by A.baumanii. Methods The clinical disitribution and drug resistance of 98 strains of A.baumanii in EICU were retrospectively analyzed from Oct. 2009 to Jan. 2011. Results Among 98 A.baumanii specimens,the dominant specimen was the sputum,which had 80 strains,taking up 81.6%.the results of antibiotic susceptibility tests showed that for most antimiembials,the drug resistance rates were high,which exceed 60%.For imipenem and Meropenem,the drug resistance rates were 49.5% and 50.6% respectively. While for Minocycline,cefopera-zone and Colistin B,their drug resistance rates were relatively lower,which taking up 21.3% ,35.6% and 6.8% respectively. Conclusion Cefopera-zone/sulbactam and carbapenems can be selected to treat A.baumanii infection experientially,then rational antibiotic drugs should be applied in time according to the resuhs of antibiotic susceptibility tests,so that nosocomial infection caused by A.baumanii could be controlled in effect. Of course,it is important that sterilization and isolation be strengthened and patient immunity be improved.