老年病人鲍曼不动杆菌感染的临床分布特点及耐药性分析

Clinical distribution and antimicrobial resistance of acinetobacter baumannii isolated from elderly patients

目的探讨老年病人鲍曼不动杆菌感染的临床分布特点及耐药性,为临床合理用药提供参考依据。方法回顾性调查317例老年病人鲍曼不动杆菌感染的临床特点及耐药性。结果纳入研究的317例中男性占64.7%,女性占35.3%;分离出的标本主要来源于痰液,占74.1%,其余分别为引流液占6.6%,全血占4.1%,尿占3.8%,胆囊胆汁占2.9%,导管占2.9%,胸腹水占2.2%,分泌物占1.6%,脑脊液及咽刷各占0.6%,皮屑及肺泡灌洗液分别占0.3%;老年病人鲍曼不动杆菌感染的科室主要是呼吸科,占40.1%,其次是重症监护室(ICU),占32.2%;药敏结果显示耐药率最低的是替加环素和阿米卡星,分别为7.4%和41.2%,其余抗菌药物的耐药率均在50.0%以上,而氨曲南、头孢唑啉、头孢西丁、头孢替坦、阿莫西林/克拉维酸、替卡西林/克拉维酸等耐药率则达到100%。结论目前老年病人鲍曼不动杆菌的分离率不断增加,研究显示细菌感染中鲍曼不动杆菌感染已居第3位。临床治疗中可选替加环素、阿米卡星等药物。

Objective To investigate the clinical characteristics and the antimicrobial resistance of Acinetobacter baumannii isolated from elderly patients in order to provide a reference for clinical rational medication. Methods A retrospective analysis was conducted of 317 cases of Acinetobacter baumannii infections among elderly patients treated in Shengjing Hospital of China Medical University between January 2015 and December 2015. Results Of all 317 patients males accounted for 64. 7% and females 35. 3%. The isolated specimens mainly came from sputum(74. 1%),followed by drainage fluid(6. 6%),blood(4. 1%),urine(3. 8%),gallbladder bile(2. 9%),catheter(2. 9%),pleural effusion and ascites(2. 2%),secretion(1. 6%),cerebrospinal fluid(0. 6%),pharynx brush(0. 6%),dander(0. 3%),alveolar avage(0. 3%). The infections were mainly found in the Department of Respiratory Medicine(40. 1%),followed by the Department of Intensive Care Unit(ICU,32. 2%). Drug susceptibility results indicated that the resistant rates of tigecycline and amikacin were the lowest,which were 7. 4% and 41. 2%,respectively. The rest of the resistant rates are over50. 0%. And the resistant rates of ammonia quna,cefazolin,cefoxitin,cefotetan,amoxicillin/clavulanic acid and ticarcillin/clavulanic acid reached 100%. Conclusions With the increase of Acinetobacter baumannii separation rate,the Acinetobacter baumannii infection has been the third bacterial infection. Therefore,it is important to attach importance to the treatment of Acinetobacter baumannii infection,for which tigecycline or amikacin can be chosen.