2006—2013年神经科ICU下呼吸道鲍曼不动杆菌医院感染调查

NOSOCOMIAL LOWER RESPIRATORY TRACT INFECTIONS CAUSED BY ACINETOBACTER BAUMANNII IN AN INTENSIVE CARE UNIT DURING 2006—2013

目的了解医院神经科ICU下呼吸道鲍曼不动杆菌(ABA)医院感染分布及耐药性变迁,为临床治疗提供理论指导。方法回顾性分析某医院神经科ICU 2006年1月—2013年12月下呼吸道ABA医院感染病人资料。ABA分离与鉴定严格按照《全国临床检验操作规程》进行,采用自动微生物分析仪ATB Expression及配套试剂进行细菌鉴定和药敏试验。结果共检出下呼吸道ABA医院感染菌株107株,占期间检出细菌比例为11.07%。其中多耐药菌株91株,占81.05%;泛耐药菌株8株,占7.48%。检出ABA对头孢哌酮-舒巴坦的敏感率较高,为93.46%;对亚胺培南、美罗培南和比阿培南的耐药率较高,分别为63.55%、63.55%和71.96%。ABA对头孢曲松的耐药率由2006年的75.0%上升到2013年的87.5%。结论神经科ICU下呼吸道医院感染ABA耐药严重,应加强对ABA耐药性监测,合理使用抗菌药物,控制ABA耐药菌率的进一步升高。

Objective To investigate the distribution and drug resistance of hospital-acquired lower respiratory tract infections caused by Acinetobacter baumannii（ABB）in neurosurgical ICU and provide theoretical directions for clinical management.Methods A retrospective analysis was conducted for data of patients with nosocomial infection caused by ABB in an ICU during Jan.2006—Dec.2013.The ABB isolation and identification were carried out in strict accordance with National Clinical Laboratory Procedures.Bacterial identification and drug sensitivity test were conducted using ATB expression and auxiliary kits. Results A total of 107 strains of ABB were isolated,accounting for 11.07% of all strains isolated from nosocomial lower respiratory tract infection in the same period,of which,91（81.05%）were multi-drug resistant,and eight（7.48%）pan-drug resistant.The ABB isolated were highly sensitive（93.46%）to Cefoperazone/Sulbactam,and highly resistant to Imipenem,Meropenem and Biapenem,being 63.55%,63.55% and 71.96%,respectively.The resistance rate of ABB to ceftriaxone elevated from 75.0%in year 2006to87.5%in 2013. Conclusion The ABB,isolated from patients with nosocomial lower respiratory infection in ICU,showed strong drug resistance.A monitoring of drug resistance of ABB should be enhanced,and antibacterials be used rationally,so as to control further increase of drug resistance in this kind of bacteria.