ICU鲍曼不动杆菌感染特点及耐药趋势

Infection by and drug resistance of the ICU-isolated Acinetobacter baumannii

目的探讨武义县第一人民医院中心ICU鲍曼不动杆菌(AB)感染特点及耐药情况。方法回顾分析2010年1月至2013年12月该院中心ICU患者分离获得的AB分布、耐药特点及临床患者资料。结果该院ICU共分离获得AB菌343株,主要来源于痰液(占67.35%),其次是创面分泌物(占11.08%)。AB对常用头孢类、碳青霉烯类、氨基糖苷类、喹诺酮类等药物耐药率高达50%以上,而对多粘菌素E、头孢哌酮/舒巴坦保持敏感性,但后两者的耐药性呈逐年上升趋势。泛耐药(PDR)AB患者血清白蛋白水平明显减低,机械通气时间、抗菌药物应有时间、ICU住院时间明显延长,死亡率增高(P<0.05)。结论 ICU获得性AB耐药率极高,仅对多粘菌素E、头孢哌酮/舒巴坦具有相对敏感性。白蛋白水平、机械通气时间、应用抗菌药物时间、ICU住院时间等可能与PDRAB感染有关。

Objective To investigate the prevalence and antimicrobial resistance of Acinetobacter baumannii （AB） in ICU. Methods The distribution and drug resistance of AB, and other clinical data of patients with AB infection in our ICU from Jan 2010 to Dec. 2013 were reviewed retrospectively. Results A total of 343 strains of AB were isolated mainly from sputum specimens （67.35%） and wound secretions （11.08% ）. The drug-resistance rates of AB to commonly used antibiotics such as eephalosporins, carbapenems, aminoglycosides and quinolones were high- er than 50%. Polymyxin E and Cefoperazone/sulbactam were the most effective agents against AB. However, the resistance rates to the two agents were both increasing gradually. Compared with the Non-PDRAB infection group, the PDRAB-infected patients had lower serum albumin, longer duration of mechanical ventilation and antibiotics treatment prolonged ICU stay and higher mortality （ P 〈 0.05 ）. Conclusion ICU-acquired AB, commonly characterized with high drug resistance, is relatively sensitive to polymyxin E and Cefoperazone/sulbactam. The factors including albumin level, length of mechanical ventilation, antimicrobial duration and ICU stay may be related with PDRAB infection.