重症监护病房的细菌分布及鲍曼不动杆菌的耐药性分析

目的 分析重症监护病房（ICU）的细菌分布及鲍曼不动杆菌的耐药性.方法 回顾性分析2009年1月至2013年9月内蒙古自治区人民医院ICU感染患者中分离出的1 079株菌株的病原菌分布和耐药性;细菌鉴定和药物敏感试验采用VITEK 2 Compact全自动细菌培养鉴定仪.结果 ICU患者中革兰阴性杆菌分离率为76.3％ （823/1 079）,其中鲍曼不动杆菌为29.2％ （315/1 079）,标本以痰液最多,为64.0％（691/1 079）;耐亚胺培南鲍曼不动杆菌（IRAB）的检出率为91.7％（289/315）.IRAB呈多重耐药,对复方磺胺甲u恶唑、妥布霉素、庆大霉素、左氧氟沙星、环丙沙星、氨苄西林舒巴坦、哌拉西林他唑巴坦、头孢他啶、头孢曲松、头孢吡肟和哌拉西林的耐药率分别为68.9％（199/289）、89.2％（257/289）、93.1％ （269/289）、94.1％（272/289）、99.7％（288/289）、98.6％（285/289）、98.6％ （285/289）、99.3％（287/289）、99.3％（287/289）、99.7％（288/289）和100.0％（289/289）,对阿米卡星耐药率较低,为22.9％（62/271）.IRAB对上述12种抗菌药物的耐药率,除复方磺胺甲（噁）唑外,均明显高于非IRAB,差异均有统计学意义（均P＜0.05）.结论 鲍曼不动杆菌在ICU的检出率较高,IRAB的分离率和耐药性较高,应加强耐药性监测,合理选用抗菌药物,有效控制IRAB的感染及流行.

Analysis of bacteria distribution resistance of Acinetobacter baumannii in Intensive Care Unit

Objective To analyze the bacteria distribution and resistance of Acinetobacter baumannii in Intensive Care Unit（ICU）.Methods Infection distribution and drug resistance of l 079 strains of pathogenic bacteria of the patients in ICU were retrospectively analyzed from January 2009 to September 2013 ; the bacteria identification and drug sensitivity were tested by VITEK 2 Compact automatic bacteria identification instrument.Results Pathogenic bacteria isolated from ICU patients with Gram negative bacilli was 76.3%,（823/1 079）,in which Acinetobacter baumannii was 29.2% （315/1 079）.Most specimens was from sputum （64%,691/1 079） ; imipenem resistant Acinetobacter （Bauman IRAB） detection rate was 91.7% （289/315）.IRAB shows multiple drug resistance; the resistant rates of the compound sulfamethoxazole,tobramycin and gentamicin,ofloxacin,ciprofloxacin,ampicillin/ sulbactam,and piperacillin/ Tazobactam,cephalosporin,ceftriaxone,cefepime and piperacillin were 68.9% （199/289）,89.2% （257/289）,93.1% （269/289）and 94.1% （272/289）,99.7% （288/289） and 98.6% （285/289）,98.6% （285/289） and 99.3% （287/289）,99.3% （287/289） and 99.7% （288/289） and 100.0% （289/289） respectively.The resistant rate for amikacin was 22.9% （62/271）.Except compound sulfamethoxazole,resistance to other 11 kinds of antimicrobial agents was evidently higher in IRAB than that to non-IRAB （P 〈 0.05）.Conclusion The detection rate of Bauman Acinetobacter in ICU is high; the isolation rate and drug resistance of IRAB is high.