2011—2012年某院ICU内88株鲍曼不动杆菌的耐药性分析

目的对本院ICU检出的88株鲍曼不动杆菌的耐药性进行分析，为临床控制和治疗鲍曼不动杆菌提供依据。方法以2011—06～2012—06笔者所在医院的ICU住院患者痰液、伤口分泌物、肺灌洗液、引流液、脑脊液为标本，共分离出鲍曼不动杆菌88株，应用VITEK-2系统进行细菌鉴定；MIC法和K—B琼脂扩散法行药敏试验；WHONET5．4软件分析鲍曼不动杆菌的耐药性。结果鲍曼不动杆菌；耐药性；抗生素鲍曼不动杆菌耐药形势严峻，其耐药率呈逐年上升趋势，且专家共识中推荐的舒巴坦制剂及碳青霉烯类药物耐药比例明显增加。88株鲍曼不动杆菌对7种临床常用治疗抗生素的耐药率由高到低分别为：头孢吡肟81．8％、亚胺培南79．5％、哌拉西林他唑巴坦77．3％、左氧氟沙星71．6％、美罗培南70．5％、头孢哌酮舒巴坦53．4％、阿米卡星11．4％。通过数据显示，阿米卡星耐药率最低。结论针对本院ICU中所分离的鲍曼不动杆菌，头孢哌酮舒巴坦和阿米卡星的体外敏感性更高，在经验性治疗中可优先考虑选择头孢哌酮舒巴坦，对于经验性治疗耐药鲍曼不动杆菌推荐头孢哌酮舒巴坦联用阿米卡星。

88 Strains of Acinetobacter Baumannii Resistance Status in Intensive Care Unit in A Hospital between 2011 -2012

Objective To analyze the resistance status of 88 strains of acinetobacter baumannii,so as to provide basis for the clinical control and treatment of acinetobacter baumannii. Methods 88 strains of acinetobaeter baumannii were separated from sputum, lung lavage fluid, specimens of secretions, cerebrospinal fluid, purulent fluid of patients in intensive care unit from June 2011 to June 2012. VITEK-2 system was used to identify the bacteria. Drug sensitive test was conducted by MIC and K-B agar diffusion method. Acinetobacter baumannii resistance was analyzed by WHONET 5.4 analysis software. Results Acinetobacter baumannii resistance situation is grim, the separating and resistant rate were increasing year by year, and multiple resistance and the resistance ratio increased significantly. Resistance to 7 clinical common antibiotic was tested in 88 strain of acinetobacter baumannii, the antibiotic resistance rate of cefepime,imipenem, piperacillin/tazobactam, levofloxacin, meropenem, cefoperazone/sulbactam, and amikaein were 81.8% , 79.5% , 77.3% , 71.6% ,70. 5% ,53. 4%, and 11. 4%, respectively. The resistance rate to amikacin was the lowest in the data. Conclusion In view of the acinetobacter baumannii tested from intensive care unit, cefoperazone sulbactam and amikacin have higher in vitro sensitivity. In the empirical treatment of common acinetobacter baumannii, cefoperazone sulbactam is the priority choice. For the empirical treatment of drug-resistant acinetobacter baumannii, cefoperazone sulbaetam combined with amikacin is recommended.