呼吸内科鲍曼不动杆菌临床特征、耐药性分析及感染与定植的监测

Clinical characteristics,drug resistance,infection and colonization of Acinetobacter baumannii in respiratory medicine

目的了解医院呼吸内科鲍曼不动杆菌感染患者临床特征、耐药性及感染与定植的监测。为预防和控制鲍曼不动杆菌医院感染及合理使用抗生素治疗提供依据。方法收集2019年1-12月本院呼吸内科临床分离的非重复鲍曼不动杆菌57株,采用VITEK-2 Compact全自动药敏分析仪对病原菌进行耐药性分析,采用WHONET 5.6软件进行数据分析。对57株鲍曼不动杆菌进行耐药性研究,并对患者的临床特征进行分析。结果鲍曼不动杆菌对氨苄西林的耐药率达100.0%,对临床常用的14种抗生素的耐药率均>50.0%,但对替加环素的耐药率仅为10.5%,敏感率高达73.7%。耐药性鲍曼不动杆菌菌株分类中,多重耐药鲍曼不动杆菌占比最高,共42例(73.6%)。临床特征中,基础疾病占比最高,共55例(96.5%),其次为高龄50例(87.7%)和长期住院45例(78.9%)。在侵入性操作中占比最高的是机械通气,共20例(35.1%)。基础疾病中占比最高的为心脑血管疾病,共44例(77.1%)。57株鲍曼不动杆菌,感染株占49.1%,定植菌株占50.9%。64.9%的患者以病情好转稳定出院,35.1%的患者出现恶化。结论呼吸内科鲍曼不动杆菌耐药性较高,耐药鲍曼不动杆菌菌株以多重耐药鲍曼不动杆菌最常见。基础疾病、高龄与长期住院为呼吸内科鲍曼不动杆菌院内感染的主要影响因素。临床医生应把握菌株的感染与定植,并根据药敏结果合理使用抗生素,减少鲍曼不动杆菌感染和耐药菌株的产生,降低死亡率。

Objective To understand the clinical characteristics,drug resistance,infection and colonization monitoring of patients with Acinetobacter baumannii infection in the Department of Respiratory Medicine of hospital.To provide basis for the prevention and control of Acinetobacter baumannii hospital infection and rational use of antibiotics.Methods 57 non-repetitive Acinetobacter baumannii strains clinically isolated from the Department of Respiratory Medicine of our hospital from January-December 2019 were collected,and the VITEK-2 compact automatic drug sensitivity analyzer was used to analyze the drug resistance of pathogens,and WHONET 5.6 was used to perform data analysis.The drug resistance of 57 strains of Acinetobacter baumannii were studied,and the clinical characteristics of the patients were analyzed.Results The resistance rate of Acinetobacter baumannii to ampicillin reached 100.0%,and the resistance rate to 14 kinds of antibiotics commonly used in clinic were all>50.0%,but the resistance rate to tigecycline was only 10.5%,and the sensitivity rate was 73.7%.In the classification of drug-resistant Acinetobacter baumannii strains,the proportion of multi-drug resistant Acinetobacter baumannii was the highest,with total of 42 cases(73.6%).Among the clinical characteristics,patients with underlying diseases accounted for the highest proportion,with 55 cases(96.5%),followed by advanced age with 50 cases(87.7%)and long-term hospitalization with 45 cases(78.9%).The highest proportion of invasive procedures was mechanical ventilation,with 20 cases(35.1%).Cardiovascular and cerebrovascular diseases accounted for the highest proportion of underlying diseases,with 44 cases(77.1%).Among 57 strains of Acinetobacter baumannii,49.1%were infected and 50.9%were colonized.64.9%of patients were discharged stably with improvement,and 35.1%of patients deteriorated.Conclusion Acinetobacter baumannii is resistant to variety of antibacterial drugs,and multi-drug resistant Acinetobacter baumannii is the most common strain.Basic diseases,advanced age and long-term hospitalization are the main influencing factors of nosocomial infection of Acinetobacter baumannii in the Department of Respiratory Medicine.Clinicians should grasp the infection and colonization of strains,and use antibiotics rationally according to the results of drug sensitivity,reduce the infection of Acinetobacter baumannii and the production of resistant strains,and reduce the mortality rate.