ICU鲍氏不动杆菌感染及耐药现状分析

Acinetobacter baumanniiinfections in ICU and analysis of drug resistance

目的了解ICU鲍氏不动杆菌临床感染与耐药现状,以指导临床用药,降低感染率。方法回顾性分析2010年1月-2012年9月ICU分离的182株鲍氏不动杆菌的感染情况及耐药性。结果 2010年1月-2012年9月鲍氏不动杆菌,在临床培养标本中总分离率从7.6%升至9.4%;鲍氏不动杆菌对头孢哌酮/舒巴坦、四环素及左氧氟沙星耐药率相对较低,分别为30.3%～31.4%、55.6%～25%及42.9%～32.5%,对亚胺培南和氨曲南的耐药率分别为61.2%和>61.4%,对其他监测的抗菌药物的耐药率均>56.2%;鲍氏不动杆菌在下呼吸道标本检出率最高,其次是泌尿生殖道、手术创口检出率分别是85.7%、4.9%和3.8%;鲍氏不动杆菌在2012年检出泛耐药株达42.0%。结论鲍氏不动杆菌是医院ICU感染中重要的条件致病菌,对抗菌药物耐药率高,感染部位主要为呼吸道,头孢哌酮/舒巴坦、四环素类及左氧氟沙星可作为治疗选择。

OBJECTIVE To understand Acinetobacter baumannii infections in the ICU and analyze the drug resistance so as to guide the clinical medication and reduce the infection rate.METHODS The status of the infections and the drug resistance of 182 strains of A.baumannii isolated from Jan 2010 to Sep 2012 were retrospectively analyzed.RESULTS From Jan 2010 to Sep 2012,the total isolation rate of A.baumannii from the clinical specimens increased from 7.6% to 9.4%;the drug resistance rate of A.baumannii to cefoperazone/sulbactam sodium varied from 30.3% to 31.4%,tetracycline from 55.6% to 25%,and levofloxacin from 42.9% to 32.5%;the drug resistance rates to imipenem and aztreonam were 61.2% and more than 61.4%,and the drug resistance rates to other antibiotics were higher than 56.2%;the detection rate of A.baumannii was the highest in the lower respiratory tract specimens（85.7%）,followed by the genitourinary tract specimens（4.9%） and the surgical wound（3.8%）;the detection rate of the pandrug-resistant A.baumannii reached up to 42.0% in 2012.CONCLUSION A.baumannii is one species of predominant opportunistic pathogens causing the nosocomial infections in the ICU,the drug resistance rate is high,the respiratory tract is the main infection site.Cefoperazone/sulbactam sodium,tetracycline and levofloxacin can be used for the treatment.