综合ICU内鲍曼不动杆菌耐药性监测及干预效果分析

Monitoring of acinetobacter baumannii infection in general intensive care unit and effect of interventions

目的分析综合重症监护病房(ICU)内鲍曼不动杆菌(AB)的耐药性,并评估干预措施的效果。方法分别采用回顾性和前瞻性调查的方法,收集2010年至2011年综合ICU内鲍曼不动杆菌感染的资料,作为干预前组;2012年实施干预措施并收集相关资料,监测三年内AB耐药性的变迁,比较干预措施前后AB、多重耐药鲍曼不动杆菌(MDRAB)、泛耐药鲍曼不动杆菌(PDRAB)感染率的差异。结果三年共检查AB感染患者332例,3年内庆大霉素(GM)、阿米卡星(AK)、米诺环素(MH)耐药率呈逐步下降趋势,头孢哌酮/舒巴坦(SCF)、亚胺培南(IPM)、美洛培南(MEM)耐药率先显著升高,后显著下降,哌拉西林(PIP)、替卡西林/克拉维酸(TIM)、哌拉西林/他唑巴坦(TZP)、头孢他啶(CAZ)、头孢噻肟(CTX)、头孢吡肟(FEP)、氨曲南(ATM)、复方新诺明(SXT)、左氧氟沙星(LEV)耐药率变化没有显著差异。2011年与2010年比较,AB、MDRAB、PDRAB感染率差异没有统计学意义,2012年与2011年比较,AB、MDRAB、PDRAB感染率显著降低,差异有统计学意义。结论综合ICU内能通过干预措施能影响AB耐药率的变迁,并能降低AB感染率,减少耐药菌株的产生。

Objective To analyze the drug resistance of acinetobacter baumannii （ AB） in intensive care u-nit （ ICU） and to evaluate the effect of intervention measures. Methods Retrospective and prospective investigations were used respectively to collect data on AB infections in ICU from 2010 to 2011, as the pre-intervention group. In-tervention measures were implemented in 2012, whose data were collected to monitor the changes in the resistance of AB to drug. The differences between the infection rates of AB, multi-drug resistant acinetobacter baumannii （MDRAB） and pan-drug resistant acinetobacter baumannii （PDRAB） before and after the intervention measures were compared to evaluate the effect of these measures. Results Over the 3 years, a total of 332 AB infection cases were diagnosed. During this period, the resistance rates of GM, AK and MH had gradually declined. The resistance rates of SCF, IPM and MEM, however, rose sharply and then dropped remarkably. The resistance rates of PIP, TIM, TZP, CAZ, CTX, FEP, ATM, SXT and LEV didn＇t have any significant difference. Compared with 2010, the infection rates of AB, MDRAB and PDRAB in 2011 showed no statistical significance. Compared with 2011, the in-fection rates of AB, MDRAB and PDRAB in 2012 decreased significantly, and the difference was statistically signifi-cant. Conclusion The use of intervention measures in ICU can affect the change of AB resistance to drug and re-duce its infection rate and the generation of drug-resistant strains.