神经外科患者医院感染鲍氏不动杆菌的耐药性分析

Drug resistance of Acinetobacter baumannii causing nosocomial infections in patients of neurosurgery department

目的调查了解神经外科住院患者感染鲍氏不动杆菌(ABA)的高发部位及耐药特点,为临床医师抗感染治疗选择敏感的抗菌药物提供实验室参考依据。方法采集神经外科2010年1月-2013年12月住院患者送检的259份感染标本;对送检标本进行病原学检测及药敏检测,药敏检测采用K-B法,采用WHONET软件对数据进行统计分析。结果共培养出ABA 259株;感染性标本以痰液、下呼吸道分泌物为最高,占59.5%;其次为尿液和切口分泌物、创伤脓液,分别占16.6%和11.2%;ABA对大部分常用抗菌药物产生了不同程度的耐药性,对磺胺甲噁唑/甲氧苄啶耐药现象最为严重,耐药率达70.7%,耐药率<20.0%的抗菌药物有阿米卡星、头孢哌酮/舒巴坦,耐药率>50.0%的抗菌药物有庆大霉素、头孢噻肟、头孢吡肟、环丙沙星、左氧氟沙星;泛耐药ABA检出率为18.9%,耐碳青霉烯类ABA检出率为27.4%。结论医院应加强细菌耐药性监测与管理,提高医师抗菌药物处方水平,控制细菌耐药性的迅速增长。

OBJECTIVE To investigate the highly prevalent infection sites of the hospitalized patients with Acinetobacter baumannii infections and analyze the characteristics of drug resistance so as to provide laboratory basis for use of sensitive antibiotics for treatment of the infections.METHODS A total of 259 infective specimens were collected from the patients who were hospitalized the department of neurosurgery from Jan 2010 to Dec 2013.The etiological examination of the submitted specimens was carried out,the drug susceptibility testing was performed by using K-B method,and the statistical analysis was conducted with the use of WHONET software.RESULTS Totally 259 strains of A.baumannii were isolated.Of the infective specimens collected,59.5% were the sputum and lower respiratory tract secretions,followed by the urine（16.6%）and wound secretions and pus（112%）.The A.baumannii strains varied in the drug resistance to the commonly used antibiotics,the drug resistance rate to sulfamethoxazole-trimethoprim reached up to 70.7%;the drug resistance rates to amikacin and cefoperazone-sulbactam were less than 20.0%,and the drug resistance rates to gentamicin,cefotaxime,cefepime,ciprofloxacin,and levofloxacin were more than 50.00%.The isolation rate of pandrug-resistant A.baumannii was 18.9%,and the isolation rate of carbapenem-resistant A.baumannii was 27.4%.CONCLUSIONIt is necessary for the hospital to strengthen the surveillance of the drug resistance,improve the level of antibiotics prescription,and curb the rapid growth of the drug resistance.