肺炎患者分离的鲍曼不动杆菌的耐药性分析和治疗策略

Drug resistance analysis and treatment of acinetobacter baumannii carried by pneumonia patients

目的通过对肺炎患者分离的102株鲍曼不动杆菌的耐药性进行分析,为治疗携带多重耐药及泛耐药鲍曼不动杆菌的患者提供理论依据。方法采用K-B纸片扩散法对19种抗生素的耐药性进行试验,采用游标卡尺测量完全抑制区的直径包括纸片的直径,抑菌环大小判读参照M100。肺炎患者的治疗分为A组和B组,A组停用所有抗生素,B组予米诺环素联合头孢哌酮-舒巴坦抗感染,两组其余治疗相同,记录结果并进行统计学分析。结果 102株鲍曼不动杆菌中多重耐药菌56株,泛耐药菌18株,非多重耐药菌28株。治疗结果显示,A组(停抗生素组)治疗效果优于B组(抗生素组)。结论肺炎患者分离的102株鲍曼不动杆菌对18种抗生素均存在不同程度的耐药性(37%-95%),但是多粘菌素类药物的耐药率为0。通过耐药性分析和治疗结果,泛耐药鲍曼不动杆菌肺炎在各种抗生素联合应用无效的情况下,停用所有抗生素不失为一种值得尝试的选择。

Objective This present study aims to provide a theoretical basis for clinical treatment of pneumonia patients with multidrugand pan-resistant Acinetobacter baumannii by drug resistance analysis of 102 isolated Acinetobacter baumannii strains. Methods K-B paper disk diffusion method was applied to the drug resistance test of 19 kinds of antibiotics; the diameters of complete inhibition zone and paper were measured by Vernier caliper. Inhibition ring test was interpreted with M100. All the pneumonia patients with Acinetobacter baumannii were separated in two groups. The pneumonia patients in A group were not treated with antibiotics, while those in B group were treated with minocycline in combination with cefoperazone and sulbactam, other treatments are identical. The results were recorded and subsequently performed with statistically analyzed. Results Among 102 isolated Acinetobacter baumannii strains, there are 56 multidrug-resistant Acinetobacter baumannii strains, 18 pan-resistant Acinetobacter baumannii strains, and 28 non-multidrug resistant Acinetobacter baumannii strains. The treatment evaluation shows that the therapeutic effects without antibiotics in A group are superior to those with antibiotics in B group. Conclusion The drug resistance rate of 102 Acinetobacter baumannii strains isolated from pneumonia patients to 19 kinds of antibiotics ranges from 37% to 95%, while the drug resistance rate to polymyxins was 0. The drug resistance analysis and treatment results suggest that it is worth trying to treat pneumonia patients with multidrug-resistant Acinetobacter baumannii without the use of any antibiotic, in the case of they are ineffective even with combined therapy.