重症监护病房的细菌分布及鲍曼不动杆菌的耐药性分析

Analysis of bacteria distribution resistance of Acinetobacter baumannii in Intensive Care Unit

目的 分析重症监护病房（ICU）的细菌分布及鲍曼不动杆菌的耐药性.方法 回顾性分析2009年1月至2013年9月内蒙古自治区人民医院ICU感染患者中分离出的1 079株菌株的病原菌分布和耐药性;细菌鉴定和药物敏感试验采用VITEK 2 Compact全自动细菌培养鉴定仪.结果 ICU患者中革兰阴性杆菌分离率为76.3％ （823/1 079）,其中鲍曼不动杆菌为29.2％ （315/1 079）,标本以痰液最多,为64.0％（691/1 079）;耐亚胺培南鲍曼不动杆菌（IRAB）的检出率为91.7％（289/315）.IRAB呈多重耐药,对复方磺胺甲u恶唑、妥布霉素、庆大霉素、左氧氟沙星、环丙沙星、氨苄西林舒巴坦、哌拉西林他唑巴坦、头孢他啶、头孢曲松、头孢吡肟和哌拉西林的耐药率分别为68.9％（199/289）、89.2％（257/289）、93.1％ （269/289）、94.1％（272/289）、99.7％（288/289）、98.6％（285/289）、98.6％ （285/289）、99.3％（287/289）、99.3％（287/289）、99.7％（288/289）和100.0％（289/289）,对阿米卡星耐药率较低,为22.9％（62/271）.IRAB对上述12种抗菌药物的耐药率,除复方磺胺甲（噁）唑外,均明显高于非IRAB,差异均有统计学意义（均P＜0.05）.结论 鲍曼不动杆菌在ICU的检出率较高,IRAB的分离率和耐药性较高,应加强耐药性监测,合理选用抗菌药物,有效控制IRAB的感染及流行.

Objective To analyze the bacteria distribution and resistance of Acinetobacter baumannii in Intensive Care Unit（ICU）.Methods Infection distribution and drug resistance of l 079 strains of pathogenic bacteria of the patients in ICU were retrospectively analyzed from January 2009 to September 2013 ; the bacteria identification and drug sensitivity were tested by VITEK 2 Compact automatic bacteria identification instrument.Results Pathogenic bacteria isolated from ICU patients with Gram negative bacilli was 76.3%,（823/1 079）,in which Acinetobacter baumannii was 29.2% （315/1 079）.Most specimens was from sputum （64%,691/1 079） ; imipenem resistant Acinetobacter （Bauman IRAB） detection rate was 91.7% （289/315）.IRAB shows multiple drug resistance; the resistant rates of the compound sulfamethoxazole,tobramycin and gentamicin,ofloxacin,ciprofloxacin,ampicillin/ sulbactam,and piperacillin/ Tazobactam,cephalosporin,ceftriaxone,cefepime and piperacillin were 68.9% （199/289）,89.2% （257/289）,93.1% （269/289）and 94.1% （272/289）,99.7% （288/289） and 98.6% （285/289）,98.6% （285/289） and 99.3% （287/289）,99.3% （287/289） and 99.7% （288/289） and 100.0% （289/289） respectively.The resistant rate for amikacin was 22.9% （62/271）.Except compound sulfamethoxazole,resistance to other 11 kinds of antimicrobial agents was evidently higher in IRAB than that to non-IRAB （P 〈 0.05）.Conclusion The detection rate of Bauman Acinetobacter in ICU is high; the isolation rate and drug resistance of IRAB is high.