医院感染鲍氏不动杆菌耐药性分析与干预

Drug resistance of Acinetobacter baumanniicausing nosocomial infections and the interventions

目的分析医院感染鲍氏不动杆菌(ABA)的耐药性、干预措施及实施效果。方法 2006-2010年采用前瞻与回顾性调查相结合的方法,对ABA进行目标性监测,2009年实施干预,采取接触隔离与建立细菌耐药预警机制。结果 5年共分离医院感染ABA 158株,其中下呼吸道感染标本占76.0%,主要分布于神经外科、骨科、呼吸内科等,5年中ABA对抗菌药物耐药率:氨苄西林82.4%～100.0%、头孢唑林82.2%～100.0%、亚胺培南11.8%～40.0%;环丙沙星、头孢他啶、氨苄西林/舒巴坦、妥布霉素等耐药率均有上升。结论医院感染ABA对抗菌药物耐药率呈上升趋势,感染部位主要为下呼吸道,实施干预措施可减少多药耐药菌的产生。

OBJECTIVE To analyze the drug resistance of Acinetobacter baumannii（ABA） causing nosocomial infection,explore the intervention measures and their efficacy.METHODS Targeted surveillance for ABA was performed by prospective survey combined with retrospective survey from 2006 to 2010,and the interventional measures were adopted in 2009,including contact isolation precaution and early warning mechanism of bacterial resistance.RESULTS Totally 158 strains of ABA were isolated in the past five years,lower respiratory tract specimens with infection accounted for 76.0%,which were widely distributed in department of neurosurgery,department of orthopaedics,and department of respiratory medicine.During the past five years,the drug resistance rates of ABA were（82.4%-100.0%）to ampicillin,（82.2%-100.0%） to cefazolin,and（11.8%-40.0%） to imipenem.The resistance rates to ciprofloxacin,ceftazidime,ampicillin/sulbactam,and tobramycin were increased,but the resistance to imipenem did not change.CONCLUSION The drug resistance rate of ABA shows an increasing trend.Lower respiratory tract was the main site of infection;the implementation of interventional measures can reduce multidrug-resistant bacteria.