鲍氏不动杆菌在ICU的分布及耐药性分析

Distribution and drug resistance of Acinetobacter baumanniiin ICU

目的分析鲍氏不动杆菌(ABA)在重症监护病房(ICU)的分布及对抗菌药物的耐药性,以指导临床合理使用抗菌药物。方法收集2010-2011年ICU 156株ABA,对分离出的菌株用VITEK-2Compoct全自动微生物鉴定系统进行鉴定,药敏试验采用琼脂扩散法进行;并根据CLSI 2011年的指导原则,判定细菌耐药率。结果本次监测的结果表明,ABA主要来源呼吸道,在156株ABA中,痰的分离率最高占84.6%,其次是支气管分泌物占5.8%、静脉插管占4.5%、血液占3.2%、引流液占1.9%;该菌在ICU分布最多且易暴发流行;对大多数β-内酰胺类抗菌药物耐药,ABA对于头孢哌酮/舒巴坦的耐药性最低为27.6%,其次为氨苄西林/舒巴坦、左氧氟沙星,其耐药率分别为56.4%、57.7%,最高的是替卡西林/克拉维酸、环丙沙星,其耐药率均达到92.3%。结论 ICU的ABA对抗菌药物的耐药性比较严重,是引起医院感染的常见条件致病菌;呼吸道感染是医院感染的危险因素之一,必须加强对ABA的耐药性监测,根据药敏试验结果指导临床合理使用抗菌药物,防止出现严重的医院感染。

OBJECTIVE To analyze the distribution and drug resistance of Acinetobacter baumannii in ICU so as to guide the rational use of antibiotics. METHODS A total of 156 strains of A. baumannii were collected from ICU from 2010 to 2011, the identification of the strains was performed with VITEK-Compact 2 automatic microbial identification system, the drug susceptibility testing was performed bY using the agar diffusion method, the drug resistance rate of the isolates was determined according to the guidelines of CLSI 2011. RESULTS The monitoring results showed that the respiratory tract was a major source of A. baumannii, of 156 strains of A. baumannii, the isolation rate from the sputum was the highest （84. 6%）, followed by bronchial secretions （5. 8%）, venous catheter （4.5%）, the blood （3. 2%）, and the drainage liquid （1. 9%）; the isolates were most prevalent and frequently occurred in ICU; the isolates were resistant to most of β-lactams antibiotics, the drug susceptibility testing showed that the drug resistance rate of A. baumannii to cefoperazone/sulbactam was the lowest （27.6 %）, the resistance rates to ampicillin/sulbactam and levofloxacin were respectively 56. 4% and 57. 7%, the drug resistance rates to ticarcillin/clavulanic acid and ciprofloxacin were the highest, both reaching to 92. 3%. CONCLUSION The drug resistance of A. baumannii isolated from ICU is serious, A. baumannii is the common opportunistic pathogens causing nosocomial infections in China; lower respiratory tract infection is one of the risk factors for nosocomial infections, it is necessary to intensify the surveillance of drug resistance of A. baumannii and reasonably use antibiotics on the basis of drug susceptibility testing so as to prevent the severe nosocomial infections.