鲍曼不动杆菌临床耐药、分布情况及感染影响因素研究

Study on clinical drug resistance, distribution and infection influencing factors of Acinetobacter baumannii

目的探讨本院分离的鲍曼不动杆菌的临床耐药情况及分布,并分析感染影响因素。方法采用纸片扩散实验法对获得的鲍曼不动杆菌予以药敏测验,并应用WHONET 5.6以及SPSS 20.0软件对鲍曼不动杆菌的分布、药敏情况予以分析,同时对鲍曼不动杆菌的感染影响因素予以单因素统计分析。结果本院2016年1月～2017年12月年培养出非重复性鲍曼不动杆菌共910株,呼吸道标本占71.21%,伤口、引流液及脓液、血液、尿液、脑脊液分别占9.45%、9.23%、2.31%、1.76%。本院鲍曼不动杆菌的科室分布,主要包括康复科、重症监护室、神经外科及神经内科。经药敏结果提示,鲍曼不动杆菌对替加环素、阿米卡星、左氧氟沙星、头孢哌酮/舒巴坦以及氨苄西林/舒巴坦的耐药率较低,其余临床常用的抗菌类药物对于鲍曼不动杆菌的耐药率均较高,其中美罗培南高达89.89%。感染影响因素主要包括格拉斯哥昏迷评分(GCS)≤8分、侵袭性操作、广谱抗菌药物以及患者住院时间≥14 d,差异有统计学意义(χ~2=7.469、7.469、9.593、7.836,P<0.05);而性别、年龄及激素治疗三项因素差异无统计学意义(P>0.05)。结论鲍曼不动杆菌具有较高耐药性,其感染主要影响因素为昏迷、侵袭性操作、广谱抗菌药物及住院时间较长,临床应针对各项因素予以有效的针对性预防。

Objective To investigate the clinical drug resistance and distribution of Acinetobacter baumannii isolated in our hospital, and analyze the influencing factors of infection. Methods The drug sensitivity of Acinetobacter baumannii was tested by disk diffusion test, and the distribution and drug sensitivity of Acinetobacter baumannii were analyzed by who net WHONET 5.6 and SPSS 20.0 software. at the same time, the influencing factors of Acinetobacter baumannii infection were analyzed by single factor statistics. Results A total of 910 strains of non-repetitive acinetobacter baumannii were cultured in our hospital from January 2016 to December 2017, respiratory specimens accounted for 71.21%, and wound, drainage and pus, blood, urine and cerebrospinal fluid accounted for 9.45%, 9.23%, 2.31% and 1.76% respectively. Department distribution of acinetobacter baumannii in our hospital mainly includes rehabilitation department, intensive care unit, neurosurgery department and neurology department.According to the results of drug sensitivity, the resistance rates of acinetobacter baumannii to tigacycline,amikacin,levofloxacin,cefoperazone/shubatan and ampicillin/shubatan were lower, and the resistance rates of other commonly used antibacterial drugs to acinetobacter baumannii were higher, among which the drug resistance rates of meropenem were up to 89.89%.The main influencing factors of infection include Glasgow coma score (GCS) less than or equal to 8 points, invasive operation, broad-spectrum antibacterial drugs and hospitalization time of patients greater than 14d, with statistically significant difference (χ^2=7.469, 7.469, 9.593, 7.836, P<0.05). There was no significant difference in sex, age and hormone therapy(P>0.05). Conclusion Acinetobacter baumannii has high drug resistance, and the main influencing factors of its infection are coma, aggressive operation,broad-spectrum antibacterial drugs and long hospitalization time, so it should be effectively targeted and prevented in clinic according to various factors.