鲁氏不动杆菌耐药性研究

Drug resistance of Acinetobacter lwoffii

目的分析医院鲁氏不动杆菌的临床分布及耐药性，为控制细菌耐药及医院感染提供依据。方法收集医院2009年2月-2012年11月住院及门诊患者分离出的非重复鲁氏不动杆菌40株，采用法国生物梅里埃公司VITEK-2Compact全自动细菌鉴定及药敏分析系统的革兰阴性杆菌鉴定卡（GNI卡），将细菌鉴定到种，采用GNS-148药敏试验卡对临床常用抗菌药物进行药敏试验。结果40株鲁氏不动杆菌主要来源于痰液15株，占37．5％，其次为分泌物及血液，分别占20．0％及12．5％；其主要分布在重症监护病房（ICU）10株，占25．0％，其次为骨科及感染科，分别占20．0％及12．5％；共检出多药耐药菌14株，检出率35．0％；鲁氏不动杆菌对头孢哌酮／舒巴坦耐药率最低，为17．5％，对亚胺培南、哌拉西林／他唑巴坦、妥布霉素、美罗培南、阿米卡星、左氧氟沙星耐药率达25．0％～37．5％，对其余抗菌药物的耐药率均〉50．00％。结论医院鲁氏不动杆菌耐药率较高，其临床主要的危险因素为抗菌药物应用与侵入性操作，应提高对鲁氏不动杆菌耐药性及临床危险因素的重视。

OBJECTIVE To investigate the clinical contribution and drug resistance of Acinetobacter lwoffii and conduct retrospective investigation on the risk factors, thus provide a basis for the control of bacteria drug resistance and nosocomial infections. METHODS A total of 40 strains of A. lwoffii were isolated from inpatients and outpatients of the hospital from Feb. 2009 to Nov. 2012. Bacteria identification was carried out by using GNI card of VITEK-2 Compact. The drug sensitivity of clinical common used antibiotics was tested by GNS-148. RESULTS Totally 15 strains of A. lwoffii were isolated from sputum（37.5%） and secretion and blood being the next, accounting for 20. 0% and 12. 5% respectively. The departmentsr distribution leading the list were ICU, orthopedics department and infectious department, occupying 25.0 %, 20.0 % and 12.5 %, respectively. Totally 14 strains of multidrug resistant organisms were detected and the detection rate was 35.0%. The drug resistance rate of A. lwoffii to cefoperazone/sulbactam was 17.5%, which was the lowest rate among other drugs. The drug resistance rates of A. lwoffii to imipenem, piperacillin/tazobactam, tobramycin, meropenem, amikacin and levofloxacin were all between 25.0% and 37.5%. The drug resistance rates of other antibiotic drugs were all 50.00%. CONCLUSIONS The drug resistance rate of A. lwoffii in our hospital is relatively high. The main clinical risk factors are antibiotics and invasive procedures. It is advisable to pay more attentions to the drug resistance and clinical risk factors of A. lwoffii.