肺部疾病患者鲍氏不动杆菌感染的分布及耐药性分析

Distribution and drug resistance of Acinetobacter baumannii infection in patients with lung diseases

目的分析肺部疾病患者鲍氏不动杆菌的分布特点及其药敏性,进而更好地防治相关感染。方法对医院呼吸科2009-2010年患者送检的标本用ATB条进行常规细菌鉴定,筛选鲍氏不动杆菌感染标本,统计分析鲍氏不动杆菌感染患者标本与病种分布;并按CLSI标准对分离的菌株进行药敏试验,分析其耐药性。结果 1020份标本中分离出鲍氏不动杆菌165株,检出率为16.2%,标本来源于痰液占57.6%、血液占21.8%、分泌物占11.5%、尿液占4.9%、其他占4.2%,其中,痰标本同其他标本相比差异有统计学意义(P<0.01);鲍氏不动杆菌病种分布以呼吸机相关性肺炎、肺癌、肺结核最多见,其中呼吸机相关性肺炎同其他疾病相比差异有统计学意义(P<0.05);鲍氏不动杆菌对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、氧氟沙星、头孢吡肟、氨曲南及哌拉西林敏感,其余均耐药,其中,亚胺培南及头孢哌酮/舒巴坦敏感率较高,分别为52.7%、38.8%,同其他抗菌药物相比差异均有统计学意义(P<0.05)。结论鲍氏不动杆菌在痰标本中检出率最高,在呼吸机相关性肺炎中最多见,耐药率高,对亚胺培南及头孢哌酮/舒巴坦较为敏感,临床应综合考虑,根据药敏试验用药以提高治疗效果。

OBJECTIVE To explore the distribution and drug susceptibility of Acinetobacter baumaanii in patients with lung diseases,so as to prevent the correlated infections.METHODS Routine bacterial identification for the submitted specimens in respiratory department from 2009 to 2010 was performed with ATB,the specimens infected with A.baumaanii were screened out,statistical analysis of A.baumaanii infections and the distribution of diseases was performed;the drug susceptibility testing for the isolates was carried out according to CLSI standards,the drug resistance was analyzed.RESULTS Totally 165 strains of A.baumaanii were isolated from 1020 specimens with the detection rate of 16.2%;the specimens mainly obtained from sputum,blood,secretions,urine and others,accounting for 57.6%,21.8%,11.5%,4.9%,and 4.2%,respectively,as compared with the sputum specimens,there were statistical significance（P0.01）;A.baumaanii commonly distributed in the patients with ventilator-associated pneumonia,lung cancer,or tuberculosis,the difference between VAP and other diseases was statistically significant（P0.05）;the result of drug susceptibility testing showed that A.baumaanii was susceptible to imipenem,cefoperazone/sulbactam,piperacillin/tazobactam,ofloxacin,cefepime,aztreonam,and piperacillin,and was resistant to the rest of antibiotics;the susceptibility rates to imipenem and cefoperazone/sulbactam were 52.7% and 38.8%,respectively,the difference in susceptibility rate was statistically significant as compared with other antibiotics（P0.05）.CONCLUSION A.baumaanii isolates are with the highest detection rate from sputum specimens and are most common in the patients with VAP,the drug resistance rate is high,A.baumaanii isolates are relatively susceptible to imipenem and cefoperazone/sulbactam,according to drug susceptibility testing to enhance the therapeutic effect,so it is necessary to take a comprehensive consideration to improve the therapeutic effect on the basis of drug susceptibility testing.