老年患者鲍曼不动杆菌感染的临床分布及耐药性监测

Distribution and Antimicrobial Resistance of Acinetobacter baumannii Isolated from Senile Patients

目的调查老年患者临床分离鲍曼不动杆菌的分布状况及对抗菌药物的敏感性,为临床合理使用抗菌药物提供依据。方法对山东某地3家医院2008年1月～2010年12月临床分离出鲍曼不动杆菌的老年患者进行病例回顾性分析。结果从临床标本中共分离出鲍曼不动杆菌872株,其中64.9%来自呼吸道、其次为脓液和尿液,分别占15.1%和12.2%;感染的主要科室为呼吸科、ICU、肿瘤科和神经内科;药敏结果显示:美洛培南、亚胺培南和头孢哌酮/舒巴坦对鲍曼不动杆菌的抗菌活性最强,耐药率分别为15.9%、18.5%和18.1%,对米诺环素的耐药率也较低,为21.1%。结论临床分离的鲍曼不动杆菌日益增多,由于鲍曼不动杆菌具有广谱耐药性,给临床治疗造成很大困难。因此,应重视鲍曼不动杆菌和多重耐药株的监测和药敏试验,严格执行消毒隔离制度,临床医师应根据药敏试验结果,合理选用抗菌药物,减少老年患者鲍曼不动杆菌感染的发生率。

Objective To investigate the clinical distribution and antimicrobial resistance of Acinetobacter baumannii isolates in se- nile patients, for guiding the rational use of antibiotics therapy. Methods We retrospectively analyzed clinical data of Acinetobacter bau- mannii infection in the elderly patients from three hospitals in Shandong during 2008 - 2010. The identification was analyzed by ATB ex- pression automatic microbiology analytical instrument system. The Kirby - Bauer agar diffusion method was applied to the antibiotic sus- ceptibility test and the results were read based on CLSI（2008） standards. Results A total of 872 pathogen strains were isolated. 566 iso- lates from sputum specimens of the largest accounted for 64.9% , followed by pus and urine, accounted for 15.1% and 12.2% , respec- tively. Respiratory, ICU, oncology and neurology were the main sections of Acinetobacter baumannii infection. Meropenem, imipenem and cefoperazone/sulbactam showed greater activity against A. baumannii, their resistant rates were 15.9% , 18.5 % and 18.1% , respective- ly. The resistance of minocycline was lower,the resistant rate was 21.1%. Conclusion The numbers of A. baumannii isolates are in- creasing. A wide spectrum of antimierobial resistance mechanisms is exhibited by A. baumannii. The clinic treatment is very difficult. We should pay much attention to detecting A. baumannii and multidrug -resistant（MDR） isolates. Furthermore, stringently executing institu- tion of disinfection and isolation are also important. Based on the drug sensitivity result, reasonably application of antibiotics should be used to decrease the incidence of A. baumannii infections in senile patients.