鲍曼不动杆菌耐药性分析及防治对策

目的：了解广西医科大学第一附属医院鲍曼不动杆菌的临床分布及对各种常用抗菌药物的耐药情况,为临床合理治疗提供依据。方法：从2009年全院患者的各种标本中分离出237株鲍曼不动杆菌,采用WHONET5.4软件对数据进行统计和分析。结果：在237株鲍曼不动杆菌标本中,痰液的构成比为67.93%,分泌物、脓液为12.24%,血液为3.37%,尿液为2.95%,引流液为2.11%,脑脊液、咽拭子均为1.27%,其他为2.95%。鲍曼不动杆菌的临床分布中,以重症监护室（ICU）为主,占44.30%;其次为内科和外科,分别占20.68%、20.25%。鲍曼不动杆菌对常用抗菌药物的耐药率以头孢哌酮/舒巴坦最低,为9.70%,其次为美罗培南及亚胺培南/西司他丁,均为44.73%。哌拉西林、哌拉西林/三唑巴坦、头孢他定、氨曲南、庆大霉素、阿米卡星、环丙沙星、左氧氟沙星、复方磺胺甲唑、头孢吡肟等的耐药率均在50%以上。结论：鲍曼不动杆菌检出标本以痰液为主,主要分布于各ICU,对多种常见抗生素耐药率有升高趋势。提示临床应加强抗生素的合理应用,防止耐药率进一步增长

Drug Resistance of Acinetobacter Baumannii and Its Countermeasures

OBJECTIVE：To investigate the clinical distribution of Acinetobacter baumannii and its resistance to common antibacterials in our hospital so as to provide references for clinical rational treatment.METHODS：237 strains of Acinetobacter baumaniis were isolated from various specimens of patients in our hospital in 2009 with the data analyzed statistically using WHONET 5.4 software.RESULTS：Among the 237 strains of Acinetobacter baumannii,67.93% were isolated from sputum,12.24% from secretions and pus,3.37% from blood,2.95% from urine,2.11% from drained liquid,1.27% from cerebrospinal fluid（CSF）,1.27% from pharynx swabs and 2.95% from the others specimen.In terms of clinical distribution of Acinetobacter baumannii,the intensive care unit（ICU） took the lead with 43% followed by medical department（20.68%） and surgery department（20.25%）.The antibiotic resistant rate of Acinetobacter baumanii to Cefoperazone/sulbactam was the lowest at 9.70%,as compared with 44.73% to Imipenem or Meropenem and 〉 50% to Piperacilli,Piperacilli/tazobactam,Ceftazidime,Atreonam,Gentamycin,Amikacin,Ciprofloxacin,Levofloxacin,Trimethoprim-sulfamethoxazole or Cefepime.CONCLUSION：Acinetobacter baumanii were mostly seen in sputum from ICU,the antibiotic resistance of which assumes an increasing trend,suggeting the imprortance of clinical rational use of antibiotics to prevent further increase of the antibiotic resistance of Acinetobacter baumannii.