分离自ICU临床标本鲍曼不动杆菌耐药性及多药耐药株感染危险因素分析

目的 分析分离自重症监护病房(ICU)标本鲍曼不动杆菌(AB)的耐药性及多药耐药AB(MDRAB)感染危险因素.方法 回顾性分析本院2009年分离自ICU标本的171株AB的耐药性,确定MDRAB、泛耐药(PDR)株及碳青霉烯类耐药株;以非多药耐药AB(NMDRAB)为对照菌株,对MDRAB感染危险因素进行分析.结果 171株AB中,63.7%(115/171)为MDRAB、34.5%(59/171)为PDRAB、60.2%(103/171)为碳青霉烯耐药菌株.MDRAB对除多黏菌素B、头孢哌酮/舒巴坦、亚胺培南以外的抗菌药物的耐药率均超过95%.17个与MRDAB感染可能相关的危险因素中,住院时间超过15 d、机械通气治疗、多部位标本分离出AB、碳青霉烯类抗菌药物治疗和神经损伤为独立危险因素;头孢菌素类、喹诺酮类抗菌药物的使用和伴有慢性阻塞性肺病是MDRAB感染的潜在危险因素.MDRAB感染或定植的致死率高于NMDRAB(P<0.05).结论 分离自ICU标本的AB中,MDRAB检出率较高,耐药性强;MDRAB感染或定植致死率高.MDRAB感染与多个独立危险因素有关,加强对独立危险因素的控制有助于预防MDRAB感染的扩散.

Drug resistance analysis of Acinetobacter baumannii isolated from clinical specimens of ICU and risk factors analysis of multi-drug resistant strain infection

Objective To investigate the drug resistance of Acinetobacter baumannii(AB) isolated from intensive care unit(ICU) specimens and the risk factors of multi-drug resistant(MDRAB) infection.Methods MDRAB,pan-drug resistant(PDR) strain and carbapenems resistant strain were confirmed by retrospective analysis of drug resistance of 171 strains of AB isolated from clinical specimens of ICU.The risk factors,related with MDRAB infection,were analyzed,taking non-MDRAB as control strains.Results Of the 171 AB isolates,67.3%(115/171) were MDRAB,34.5%(59/171) were PDR strains and 60.2%(103/171) were carbapenems resistant strains.The resistant rates of MDRAB to most antibiotics were extremely high,more than 95%,except for polymyxin B,cefoperazone/sulbactam and imipenem.Among the 17 MRDAB infection related factors,5 were independent risk factors,including length of stay(>15 d),mechanical ventilation,multiple isolates,carbapenems usage and neurologic impairment,and usage of cephalosporins and quinolones and accompanied by COPD might be potential risk factors.MDRAB was associated with significant mortality when compared with non-MDRAB(P<0.05).Conclusion The epidemic of MDRAB was extremely serious,especially in ICU.Drug resistance of MDRAB isolates was strong.Infection or colonization of MDRAB might be related with high mortality rate.MDRAB infection might be related with multiple independent risk factors,and strengthening controls on these factors could effectively prevent the spread of MDRAB infection.