我院鲍曼不动杆菌的耐药情况分析及对策

目的了解临床分离的鲍曼不动杆菌的耐药性,为各科室抗感染治疗及合理使用抗菌药物提供依据。方法采用常规细菌培养方法从临床各种送检标本中分离出细菌,以Micro-Scan Walkaway 40微生物分析仪鉴定菌种并进行体外药物敏感(药敏)试验,在上述方法分离的鲍曼不动杆菌对14种抗菌药物全部耐药时,再使用K-B法测定鲍曼不动杆菌对头孢哌酮-舒巴坦钠的耐药情况。结果 2010年1月～2011年5月我院共分离出鲍曼不动杆菌479株,占分离细菌总数的13.8%。鲍曼不动杆菌主要分布在急诊科、呼吸内科和重症监护病房等,除头孢哌酮-舒巴坦钠外,鲍曼不动杆菌对14种抗菌药物的耐药率重症监护病房为89.0%～97.1%,胸外科为84.2%,急诊科为59.6%～97.9%,呼吸内科为66.4%～93.5%,神经内科为56.7%～73.0%,心内科为13.3%～20.0%。结论鲍曼不动杆菌对头孢哌酮-舒巴坦钠体外药敏活性强,头孢哌酮-舒巴坦钠可作为多药耐药鲍曼不动杆菌感染的首选药物。临床应加强药敏监测,并建立切实有效的感染控制措施,阻断多药耐药菌传播。

Analysis and Countermeasures of Resistance of Acinetobacter Baumannii in Shunyi District Hospital of Beijing

Objective To investigate the drug resistance of Acinetobacter baumannii isolates from different sections in our hospital and to provide reference of anti-infection treatment and rational use of antibiotics in different departments.Methods The bacteria were isolated from specimens by conventional bacterial culturing,identified by the MicroScan Walkaway 40 microbial species analyzer and then vitro susceptibility testing(drug sensitivity tests) was performed.When Acinetobacter baumannii were resistant to all 14 antibiotics,drug resistance to Cefoperazone sulbactam was tested using K-B method.Results 479(13.8%) acinetobacter baumannii strains were isolated during January 2010 and May 2011.Acinetobacter baumannii was found mainly in emergency department,department of respiratory diseases and intensive care unit(ICU).Apart from Cefoperazone sulbactam,the resistance rate of Acinetobacter baumannii to 14 antibiotics were 89.0%-97.1% in ICU,84.2% in department of chest surgery,59.6%-97.9% in emergency department,66.4%-93.5% in department of respiratory diseases department of respiration,56.7%-72.3% in neurology department,13.3%-20.0% in department of cardiology.Conclusion Cefoperazone sulbactam can be used as the preferred medication because of its high drug sensitivity in vitro.Susceptibility monitoring should be strengthened,and rational use of antimicrobial drugs and the establishment of effective infection control measures should be taken to block the spread of multi-drug resistant bacteria.