医院感染鲍氏不动杆菌的临床分布及耐药性分析

目的:了解2008-01-20120-12临床分离的221株鲍氏不动杆菌(ABA)的标本来源、感染科室分布及耐药状况,为临床预防和治疗感染性疾病提供参考依据。方法:采用临床微生物学检验的常规方法对感染性标本进行细菌培养、鉴定和药敏试验,调查221株ABA的标本来源和感染科室,统计ABA对12种常用抗菌药物的耐药率。结果:221株ABA中有182株来自痰液,占82.4%;其次是脓液和手术切口引流物、血液等。医院感染ABA主要分布在重症监护病房(ICU),占51.6%;其次是呼吸内科24.4%和神经外科19.5%。药敏结果显示:ABA对临床常用抗生素的耐药性逐年增长,ABA耐药率最低的抗生素是头孢哌酮/舒巴坦,其次是亚胺培南、美洛培南。对青霉素类、氨基糖苷类、氟喹诺酮类、氨曲南、哌拉西林/他唑巴坦等呈高度耐药(90%),且表现出多药耐药性。结论:ABA医院获得性感染率逐年增加,并对多种抗菌药物耐药,且多药耐药性明显,应引起临床尤其是ICU病房和呼吸内科高度重视,应严格做好各种侵入性操作的无菌技术,合理使用抗生素,以降低医院感染率、提高治愈率,延缓细菌耐药性的产生。

Clinical distribution and drug resistance of Acinetobacter baumannii causing nosocomial infection

Objective：To determine the specimens source, infection distribution and drug resistance of Acinetobacter baumannii （ABA） isolated from our hospital from Jan. 2008 to Dec. 2012 and provide evidence for clinical prevention and treatment of it. Method： Bacterial cultivation, identification and susceptibility testing were performed by the microbiological routine methods. The specimens source and department distribution of 221 ABA had been summarized and analyzed retrospectively, resistance rates of 12 commonly used antimicrobial drug had be counted. Result： 182 strains in a total of 221 A. baumannii strains were isolated from sputum accounting for 82.4%, followed by pus, drainage incision, blood, and so on. The majority of ABA causing nosocomial infection was observed in ICU （51.5%）, followed by respiratory medicine （24.4%）, neurosurgery （19.9%） and other departments. Susceptibility results showed that ABA resistant to commonly used antibiotics increased year by year. Resistance rate of cefoperazone/sulbactam was the lowest, followed by imipenem, meropenem. ABA were highly resistant to penicillins, aminoglycosides, fluoroquinolones, aztreonam, piperacillin/tazobactam （〉 90 % ）, and showed multiple drug resistance. Conclusion： Concurrence of nosocomial infection caused by ABA increased year by year. It was highly resistant to common antimicrobials and demonstrated distinct multi-drug resistance. This should lead to clinical attention, especially in ICU and Respiratory Medicine. Improve treatment efficacy and reduce drug-resistant strains by strictly operating aseptic technique of invasive procedures and using antibiotics rational.