二级医院鲍曼不动杆菌感染的临床特征和同源性分析

Clinical characteristics and homology in Acinetobacter baumannii

目的研究二级医院鲍曼不动杆菌感染患者的临床特征，对耐碳青霉烯鲍曼不动杆菌进行同源性分析，为临床治疗和医院感染控制提供依据。方法收集临床分离的115株非重复性鲍曼不动杆菌，回顾性分析患者的临床资料和细菌药敏资料。采用Vitek2Compact对115株鲍曼不动杆菌进行19种抗菌药物的敏感性检测。采用肠杆菌科基因间一致重复序列聚合酶链技术（ERIC-PCR）对其中的耐碳青霉烯鲍曼不动杆菌进行基因分型和同源性分析。结果115例患者主要集中在ICU、干部病房和呼吸科病房。患者的平均年龄为（75±16）岁。平均住院时间52．1d。最常见的合并症为COPD和糖尿病。72例（62．61％）患者曾接受侵入性操作。86例（74．780）患者病程中使用过2种及以上的抗生素。48例（41．74％）患者接受机械通气。115株鲍曼不动杆菌对多黏菌素B耐药率最低，为0％，其次为替加环素，耐药率7．83％。仅头孢哌酮／舒巴坦、阿米卡星耐药率低于40％，对其他常用抗生素的耐药率均高于50％。对亚胺培南和美罗培南的耐药率分别达56．52％和58．26％。ERIC-PCR技术将67株耐碳青霉烯鲍曼不动杆菌分为9个基因型。结论二级医院鲍曼不动杆菌感染患者的临床特征为：高龄，住院时间长，合并基础疾病，接受侵入性操作，接受机械通气及使用多种抗生素。对常用的抗生素高度耐药。多重耐药鲍曼不动杆菌及广泛耐药鲍曼不动杆菌存在院内接触传播的现象，因此应该提高医护人员消毒意识，加强耐药性监测及合理使用抗菌药物。

Objective To investigate the clinical characteristics and homology in Acinetobacter baumannii from cilinical isolates. Methods A retrospective analysis was performed on the clinical and antimicrobial sensitivity data. Identification of the clinical Acinetobacter baumannii isolates and susceptibility testing were performed using Vitek2 Compact. Genotyping and homology of 115 strains of Acinetobacter baumannii were analyzed by enterbacterial repetitive intergenic consensus （ERIC）- polymerase chain reaction（PCR）. Results The mean age of the patients was （75 ± 16） years old. The most frequent comorbidity were chronic obstructive pulmonary disease （COPD） and diabetes mellitus. 72 （62.61% ） patients were under invasive procedure. 86 （74.78 % ） patients used more than two antibiotics. Mechanical ventilation were used in 48（41.74%） patients. The 115 strains of Acinetobacter baumannii remained sensitive to colistin （resistance rate 0 % ）, followed by Tygecycline （resistance rate 7.83 % ）. The 115 strains were identified as 9 epidemic clones. Conclusions The risk factors of nosocomial infection caused by Acinetobacter baumannii included advanced age, presence of comorbidity, invasive procedures,mechanical ventilation and the use of more than two antibiotics. The strains of Acinetobacter baumannii were resistant to most of the antimicrobial agents.