老年呼吸机相关性肺炎鲍氏不动杆菌感染的耐药性分析

Drug resistance of Acinetobacter baumanniicausing ventilator-associated pneumonia in senile patients

目的研究老年呼吸机相关性肺炎(VAP)鲍氏不动杆(ABA)感染的耐药特征,提高临床对鲍氏不动杆菌防治水平。方法对131例老年呼吸机相关性肺炎(VAP)患者分离的69株鲍氏不动杆菌进行药敏试验,并对抗菌药物耐药结果进行回顾性分析。结果 69株鲍氏不动杆菌对头孢哌酮/舒巴坦的耐药率最低,为44.93%;其次为亚胺培南、美罗培南和哌拉西林/他唑巴坦均为47.83%,对其余11种抗菌药物的耐药率均为60.87～97.10%;共检出33株耐亚胺培南ABA,泛耐药株(PDR)2株。结论鲍氏不动杆菌对常用抗菌药物呈多药耐药(MDR);在老年呼吸机相关性肺炎(VAP)感染已十分严重,其首选药物为头孢哌酮/舒巴坦、亚胺培南、美罗培南和哌拉西林/他唑巴坦;应加大对鲍氏不动杆菌耐药性的监测力度,强调根据药敏结果选择用药。

OBJECTIVE To investigate the characteristics of drug resistance of Acinetobacter baumannii causing ventilator-associated pneumonia（VAP） in elderly patients so as to improve the level of clinical prevention of A.baumannii infections.METHODS A total of 131 geriatric patients with VAP were monitored.The drug susceptibility testing was performed for 69 isolates of A.baumannii isolated from the patients,the results of the drug susceptibility testing were analyzed retrospectively.RESULTS Totally 69 strains of A.baumannii showed the lowest drug resistance to cefoperazon/sulbactam（44.93%）,followed by imipenem,meropenem and piperacillin/tazobactam（47.83%）;the drug resistance rates to the rest of 11 antibiotics varied from 60.87% to 97.10%.A total of 33 imipenem-resistant strains and 2 pandrug-reistant strains were detected.CONCLUSION A.baumannii shows multidrug-resistant to commonly used antimicrobial agents;A.baumannii infections in the elderly patients with VAP has been extremely severe;cefoperazone/sulbactam,imipenem,meropenem and piperacillin/tazobactam are preferred for the treatment;it is necessary to strengthen the surveillance of the drug resistance of A.baumannii and use antibiotics on the basis of the result of drug susceptibility testing.