鲍曼不动杆菌的临床分布、耐药情况及其感染危险因素分析

Clinical distribution and drug resistance of Acinetobacter baumannii and the risk factors of the infections

目的调查2014年1月至12月浙江大学附属第一医院分离的鲍曼不动杆菌的分布情况、耐药性及其感染相关危险因素,为临床鲍曼不动杆菌的防治提供依据。方法对培养得到的鲍曼不动杆菌进行鉴定,采用纸片扩散法进行药敏试验,采用WHONET 5.6软件对鲍曼不动杆菌的分布及药敏结果进行回顾性分析,采用SPSS 22.0软件对鲍曼不动杆菌的危险因素进行单因素分析。结果 2014年共培养到非重复鲍曼不动杆菌917株,标本主要来源为痰液,占71.2%;伤口、脓液及引流液占9.9%;血培养占9.7%;导管来源标本占3.1%。鲍曼不动杆菌分布科室情况:重症监护室占47.7%;神经外科占19.1%;肝胆外科占13.5%;感染科占7.0%。体外药敏试验结果显示,除阿米卡星、替加环素外,临床常用抗菌药对鲍曼不动杆菌的耐药率均大于40.0%,美罗培南的耐药率最高为89.7%。危险因素分析显示:有侵入性操作、GCS评分≤8分、住院时间>14d及使用广谱抗菌药物治疗是鲍曼不动杆菌感染发生的危险因素(P<0.05)。结论鲍曼不动杆菌的耐药率高。侵入性操作、昏迷、住院时间延长及使用广谱抗菌药物是鲍曼不动杆菌感染发生的危险因素,临床医师应针对各危险因素对鲍曼不动杆菌感染进行有针对性的防治。

Objective To investigate the distribution and drug resistance of Acinetobacter baumannii isolates from January to December 2014 in The First Affiliated Hospital of Zhejiang University, analyze the risk factors of the infections, and provide theoretical basis for prevention and treatment of Acinetobacter baumannii in the future. Methods Clinical isolates of Acinetobacterbaumannii during 2014 in our hospital were collected and identified. Antimicrobial susceptibility test was performed using K-B method. Retrospective analysis was conducted on the distribution and drug resistance rates with WHONET 5.6 software. The risk factors of Acinetobacter baumannii infection were analyzed with univariate statistics analysis by SPSS 22.0 software. Results A total of 917 strains of non-repeated A. baumannii were identified, most of which were from sputa （71.2 % ）, followed by secretions and pus （9.9 % ） ; 9.7 % of the strains were isolated from blood and 3.1% from medical ducts. The primary department where the strains were from was ICU （47.7%）, followed by the department of neurosurgery （19.1%）, hepatobiliary surgery （13.5%）, and the infectious department （7.0%） . The resistance rates of Acinetobacter baumannii to common clinical antimicrobials were more than 40%, except to Amikacin and Tigecycline, while that to Meropenem was the highest at 89.70/00. Univariate analysis revealed that invasive operations, Glasgow coma score 48, length of hospital stay 〉14 days and usage of broad-spectrum antibiotics were the risk factors of nosocomial infection by Acin-etobacterbaumannii （P〈0. 05） . Conclusion The drug resistance rate of Acinetobacterbaumannii is high. The risk factors include invasive operation, coma, extension of hospital stay and usage of broad-spectrum antibiotics. Comprehensive management should be encouraged to control Acinetobacter baumannii infections.