ICU鲍氏不动杆菌感染及耐药性分析

Acinetobacter baumanniiinfections in ICU and analysis of drug resistance

目的调查分析重症监护病房(ICU)鲍氏不动杆菌医院感染和耐药性,为控制医院感染和治疗提供依据。方法对医院2010-2011年ICU分离的鲍氏不动杆菌共206株采用纸片扩散法对12种抗菌药物进行药物敏感试验,并选择60株耐亚胺培南鲍氏不动杆菌(IRAB)和30株亚胺培南敏感鲍氏不动杆菌(ISAB)进行耐药性比较分析。结果鲍氏不动杆菌对头孢西丁、头孢他啶、头孢吡肟、哌拉西林/他唑巴坦、左氧氟沙星、磺胺甲噁唑/甲氧苄啶、庆大霉素、亚胺培南、阿米卡星耐药率均>70.0%,对氨苄西林/舒巴坦和米诺环素耐药率均>50.0%,对头孢哌酮/舒巴坦耐药率较低,为36.9%;IRAB与ISAB比较,IRAB对氨苄西林/舒巴坦、头孢他啶、阿米卡星耐药率均>90.0%,而ISAB耐药率分别33.3%、23.3%、26.7%,对左氧氟沙星、米诺环素耐药率>80.0%,而ISAB耐药率分别30.0%、23.3%,除头孢西丁、磺胺甲噁唑/甲氧苄啶耐药性较一致外,对其他抗菌药物耐药率差异有统计学意义。结论鲍氏不动杆菌是ICU医院感染重要病原菌之一,其耐药率高,耐药谱广,应加强医院感染控制力度,合理使用抗菌药物。

OBJECTIVE To investigate and analyze the drug resistance of Acinetobacter baumannii causing nosocomial infections in ICU so as to provide basis for the control and treatment of nosocomial infections.METHODS A total of 206 strains of A.baumannii isolated from ICU during 2010-2011 were selected,the drug susceptibility testing for 12 antibiotics was performed with disc diffusion method.The drug resistance of 60 strains of imipenem-resistant A.baumannii（IRAB） and 30 strains of imipenem-sensitive A.baumannii（ISAB） was compared.RESULTS The drug susceptibility testing indicated that A.baumannii strains were highly resistant to cefoxitin,ceftazidime,cefepime,piperacillin-tazobactam,levofloxacin,trimetoprim-sulfamethoxazole,gentamycin,imipenem,and amikacin,with the drug resistance rate more than 70.0%,the drug resistance rates to ampicillin-sulbactam and minocycline were higher than 50.0%,the drug resistance rate to cefoperazone-sulbactam was 36.9%.As compared the IRAB and ISAB,the drug resistance rates of the IRAB strains to ampicillin-sulbactam,ceftazidime,and amikacin were higher than 90.0%,and the drug resistance rates of the ISAB strains were 33.3%,23.3% and 26.7%,respectively,the drug resistance rates of the IRAB strains to levofloxacin,and minocycline were higher than 80.0%,while the drug resistance rates of the ISAB strains were 30.0% and 23.3%,respectively.The drug resistance to cefoxitin and trimetoprim-sulfamethoxazole was consistent,and the difference in the drug resistance rate to other antibiotics was statistically significant.CONCLUSION A.baumannii is one of the predominant species of the pathogens causing nosocomial infections in ICU and is highly drug resistant with broad drug resistant spectrum.It is necessary to strengthen the control of nosocomial infections and reasonably use of antibiotics.