鲍曼不动杆菌的流行病学调查与耐药性分析

目的：了解鲍曼不动杆菌医院感染分布特点及对常用抗菌药物的耐药性，为指导临床合理选用抗菌药物提供科学依据。方法：对甘肃省中医院2009年1月至2010年3月间临床标本分离出来的33株鲍曼不动杆菌的药敏试验结果进行回顾性调查和分析。结果：鲍曼不动杆菌以骨外科病区分布最多，占45．45％；其次是神经内科病区，占27．27％。鲍曼不动杆菌标本来源以痰标本为主，占54．55％；其次是伤口分泌物标本，占39．39％。该菌耐药现象较为严重，在常用抗菌药物药敏试验中，鲍曼不动杆菌多重耐药率较高，妥布霉素、庆大霉素耐药率最高；对青霉素类、头孢菌素类、氟喹诺酮类等临床常用抗菌药物耐药率在60．O％以上。亚胺培南对鲍曼不动杆菌的抗菌活性最高，可作为抗菌药物治疗首选。结论：临床治疗应根据该菌在本院内的药敏结果合理选用抗菌药物，有效控制鲍曼不动杆菌在医院内的定植和播散。一旦出现多重耐药株，必须迅速采取控制措施，加强对患者的管理，做好消毒隔离措施，避免引起院内感染的暴发流行。

Analysis on Drug Resistance and Epidemiological Investigation of Acinetobacter Baumannii

Objective： To provide scientific evidence for guide of rational use of antibacterials by knowing distribution characters of acinetobacter baumannii in hospital infection and drug resistance of antibacterials. Method： Thirty-three strains of acinetobacter baumannii were isolated from clinical specimen of January, 2009 to March, 2010 in Gansu Province Hospital of Traditional Chinese Medicine and the results of allergic reaction were retrospectively investigated and analyzed. Result： There is the most acinetobacter baumannii distributed over the ward of bone surgery and reaches 45.45%; the next is neurological department and account for 27.27%. Phlegm is the main specimen origin of acinetobacter baumannii and occupies 54.55%; the next is secretion of wound and holds 39.39%. The phenomenon of drug resistance is severe, multiple drug resistance rate of acinetobacter baumannii is much higher, and drug resistance rates of tobramycin and gentamycin are the highest ones; the rates of clinical antibacterials including penicillin, cephalosporins and fluroquinoloncs reach more than 60.0%. Imipenem, as the first choice of antibacterials, show the highest antibacterial activity to acinetobacter baumarmii. Conclusion： We should choose antibacterials according to allergic result of bacteria in hospital to effectively control plant and spread of acinetobacter baumannii. Once multiple antibiotic resistant strains occurred, we must take control measures rapidly, enhance the management of patients and make disinfection measures to avoid outbreak of hospital infection.