鲍曼不动杆菌医院内感染的危险因素及耐药性分析

目的了解3年来鲍曼不动杆菌在顺德第一人民医院院内感染的流行特征及鲍曼不动杆菌对常用的15种抗生素的耐药性变化特征,为指导临床合理选用抗生素提供科学的依据,以及探讨鲍曼不动杆菌医院感染的危险因素。方法对顺德第一人民医院2005-01~2007-12间,临床样本分离的鲍曼不动杆菌的药敏试验结果进行回顾性分析。结果医院感染的鲍曼不动杆菌主要分布在颅脑外科及重症监护病房,占33.97%。标本来源以呼吸道标本为主,占89.10%。在常用的15种抗生素药敏试验中,头孢唑啉、氨苄青霉素和呋喃坦啶的耐药率始终处于高水平达100%。在3年的耐药性分析发现,头孢类药物的耐药率各有差异,其中头孢唑啉的耐药率3年均达100%,而头孢曲松的耐药率3年均高于头孢他啶的耐药率。亚胺硫霉素的耐药率最低,3年耐药率均为1.72%、4.00%、14.57%,可作为抗菌药物治疗首选。但亚胺硫霉的耐药率呈现逐年上升趋势。复方新诺明、庆大霉素和妥布霉素3年间的耐药率保持较稳定水平,3年无显著性差异(P>0.05)。而其它药物耐药率在07年均比05、06年有显著性上升趋势(P<0.05)。颅脑外科及重症监护病房分离株对丁胺卡那霉素、氨苄青霉素/舒巴坦、复达欣(头孢他啶)、菌必治(头孢曲松)、环丙沙星、庆大霉素、亚胺硫霉素、妥布霉素、复方新诺明、呱拉西林/他唑巴坦、头孢吡肟(马斯平)、左旋氧氟沙星的耐药率均高于其他普通病房(P<0.05)。结论应根据该菌在本院的药敏结果进行抗生素的选择,并对高危患者高发生率的颅脑外科及重症监护病房应进行密切监测,一旦出现多重耐药株,必须迅速采取控制措施,避免引起医院内感染的暴发流行。

Analysis on Drug Resistance and Risk Factors of Acinetobacter Baumannii in Nosocomial Infection

Objective To realize the prevalence of Acinetobacter baumannii in nosocomial infection（NI） and the changes of drug resistance of 15 antibiotics in 3 years. And to provide evidence to proper use of antibiotics in clinic, In addition to investigate the risk factors of Acinetobacter baumannii in nosocomial infection. Methods Acinetobacter baumannii was isolated from clinical specimens between 2005 and 2007, antimicrobial susceptibility test was retrospectively analyzed. Results All of the cases who were infected Acinetobacter baumannii were mainly came from the department of department of cerebral surgery and ICU. The example mainly isolated from sputum. The result of the antibiotics sensitivity test shows： the drug resistant of Cefazolin,Ampicillin and Nitrofurantoin were in a high level （the rate was up to 100 percent）. The drug resistance rate of cephalosporins has discrepancy , such as Cefazolin was 100%, and the resistant rate of ceftriaxone are higher than cefazidime （ P 〈 0.05）. The rate of imipenem was lowest among them and it can be used by the first choice inantibacterial drug. It＇ s drug resistant rate was 1.72 %, 4.00 %, 14.57 % in 3 years. However, the drug resistant rate of imipenem was increased year by year. Bactrim, gentamycin and tobramycin has maintenance level without significant difference（ P 〉 0.05）. The rate of the other drugs have significance upgrade trendcy in 2007 than 2006（ P 〈 0.05）. Higher resistance rate was observed in Amikacin. Amipicillin/Sulbactam. Cefazidime. Ceftriaxone. Ciprofloxacin. Gentamicin. Imipenem. Tobramycin. Trimethoprim/Suffa. Piperacillin/tazobac. Cefepime.Levofloxacin among the strains from brain surgery department and ICU patients than those from the other inpatients （ P 〈0.05）. Conclusion To choose antibiotics should be according to the result of drug sensitive test. Department of cerebral surgery and ICU should be monitored closely. And if resistance strain was founded, regulate measure must be taken at once to avoid outbreaks in hospital.