鲍曼不动杆菌院内下呼吸道感染临床特征及耐药性分析

目的了解鲍曼不动杆菌(AB菌)医院内下呼吸道感染的临床特征及其耐药现状,为临床诊治提供依据。方法对惠州市中心人民医院2007年1月至2009年12月收治的161例痰培养有AB菌生长的患者,按照卫生部2001年制定的医院感染诊断标准划分为感染组和定植组,回顾性分析其临床特点、危险因素等,同时对AB菌株的体外药敏试验资料进行总结分析,采用SPSS13.0软件对数据进行统计处理。结果 3年来院内分离出343株AB菌,其中278株分离自痰液,占81.0%(278/343),来源于161例患者,其中细菌定植84例(52.2%),细菌感染77例(47.8%)。发生AB菌院内下呼吸道感染的独立危险因素是早期使用第3代头孢菌素相对危险度(OR)=7.27]、肺癌感染临床肺癌感染评分(CPIS)≥6分,OR=6.50]、入住重症监护病房(OR=3.55)、早期使用抗生素超过2周(OR=2.48)。药敏监测结果表明该菌广泛耐药,耐药率最低的是头孢哌酮/舒巴坦(2.34%),其次是亚胺培南(19.53%)、美罗培南(22.66%)。结论 AB菌是医院感染的重要病原菌,广泛耐药,应重点监测和采取积极的预防措施,尽可能减少该菌在呼吸道的定植和发病。

Clinical feature and drug resistance of lower respiratory nosocomial infection caused by Acinetobacter baumannii

Objective To investigate the clinical feature and drug resistance of lower respiratory nosocomial infection caused by Aeinetobacter baumannii（AB） ,so as to provide reference for the clinical treatment. Methods By a retrospective study,a total of 161 sputum cultures as AB were collected from January 2007 to December 2009 and according to the diagnostic criteria of nosocomial infection developed by, Ministry of Health in 2001 divided into infection and colonization groups. To retrospectively analyze the clinical characteristics, risk factors. Meanwhile, AB strains in vitro drug sensitivity tests were analyzed and summarized. All the data were analyzed by SPSS 13.0 soft ware. Results 343 AB strains were isolated during 3 years,278 strains from sputum,accounting for 81.0% （278/ 343） ,from 161 patients,colonization in 84 patients （52. 2%） ,infection in 77 patients （47.8%）. AB occurred nosocomial lower respiratory tract infection bacteria were identified four independent factors： early use of third-generation cephalosporins（OR=7.27） ,clinical pulmonary infection score （CPIS）≥6（OR= 6.50） ,stay in ICU（OR= 3.55） ,early antibiotic use〉2 weeks （OR=2.48）. The antibiotic susceptibility test in vitro showed：drug resistance of AB was a serious problem, the resistant rate to cefoperazone sulbactam was lowest （2. 34%）, followed by imipenem （19.53%）, meropenem （22. 66 % ）. Conclusion AB bacterial pathogen is an important nosocomial infection source with extensively drug resistance. Should focus on monitoring and take active preventive measures to minimize bacteria in the respiratory tract colonization and infection.