综合性医院重症监护室鲍曼不动杆菌耐药性分析

Drug resistance of Acinetobacter baumannii in ICU of general hospital

目的了解重症监护室病人鲍曼不动杆菌感染及耐药情况,指导临床医师选择有效抗生素进行抗感染治疗,控制院内感染的发生。方法 2008年1月～2010年1月期间,自重症监护室病人痰液等标本分离鲍曼不动杆菌,分析细菌的标本分布和科室分布,并检测细菌对常用抗生素的耐药性。细菌鉴定用VITEK-GNI+,药敏试验采用K-B法。结果分离出172株鲍曼不动杆菌,主要来自呼吸道感染病人的痰液,占87.21%;综合性重症监护室鲍曼不动杆菌的检出率较高,为43.60%(ICU-1)和29.65%(ICU-2)。药敏试验显示鲍曼不动杆菌对米诺环素、亚胺培南、含酶抑制剂的复合制剂如头孢哌酮/舒巴坦和哌拉西林/他唑巴坦以及左氧氟沙星的耐药率低,分别是1.32%、5.88%、4.71%、17.65%和23.53%,对其他抗生素有较强的耐药性。结论鲍曼不动杆菌是ICU病人呼吸道感染的常见菌,且耐药性高,建议首选米诺环素、亚胺培南、头孢哌酮/舒巴坦,哌拉西林/他唑巴坦和左氧氟沙星进行鲍曼不动杆菌的感染治疗。

Objective To investigate Acinetobacter baumannii infection and drug resistance in patients in the ICU and to instruct clinicians in choosing effective antibiotics in order to treat infections and control the incidence of nosocomial infection.Methods A total of 172 A.baumannii strains were isolated from patients in the ICU from January 2008 to January 2010.VITEK-GNI＋ was used to identify bacteria,drug susceptibility testing was done using the Kirby-Bauer method,and results were subjected to regression analysis with SPSS.Results Of the isolated strains,172 were mainly isolated from the sputum of patients with a respiratory tract infection,accounting for 87.21% of the isolates.The detection rate was highest in the regular ICU.A.baumannii was least resistant to MH（1.32%）,followed by IPM（5.88%）,SCF（4.71%）,TZP（17.56%）,and LEV（23.53%）.However,the isolates were highly resistant to other antibiotics.Conclusion A.baumannii is a common bacterium in the ICU.It can result in respiratory tract infections and is highly drug-resistant.Its detection and analysis is crucial.MH is recommended as the antibiotic of choice to treat A.baumannii infections,followed by IPM,SCF,TZP,and LEV.