2009-2011年鲍曼不动杆菌在呼吸道感染的临床分布及耐药性变迁

目的:分析呼吸道感染患者鲍曼不动杆菌的感染情况及耐药变迁。方法:按照《全国临床检验操作规程》(第3版)采集海医附院2009年1月～2011年12月住院的17 907例呼吸道感染患者的痰标本,并采用全自动微生物分析仪及配套试剂进行细菌鉴别和药敏实验。结果:17 907例呼吸道感染患者分离到5 372株致病菌,其中鲍曼不动杆菌206株,在不同的性别感染率无差别;年龄组感染率不同,以60岁以上老年人多见;四季分布不同,以秋季节多见;以ICU多见。药敏结果显示:3年鲍曼不动杆菌对头孢吡肟、头孢噻肟的耐药率总体呈变化不大;对左氧佛沙星、头孢他啶、复方新诺明、氨基糖苷类(庆大霉素、妥布霉素、阿米卡星)的耐药率呈大幅下降;而对哌拉西林/他唑巴坦、亚胺培南、美罗培南的耐药率逐年上升。结论:海南医学院附属医院呼吸道感染患者鲍曼不动杆菌的感染率无性别差异,与季节、年龄及病区有关。药敏结果显示鲍曼不动杆菌对抗菌药物存在多耐药性,临床应根据其药敏结果选择合理的抗菌药物。

Clinical distribution and drug resistance change of respiratory nosocomial infections of Acinetobacter baumannii

Objective: To investigate the clinical distribution and drug resistance of lower respiratory nosocomial infections caused by Acinetobacter baumannii.Methods:Sputum specimens were collected from 17 907 inpatients from January 2011 to December 2011 who were treated according to the national clinical laboratory produres(3rd editon).The incidence of positive Acinetobacter baumannii and the rate of resistance to different antibiotics were calculated.Results: Of the total 5372 cases,206 strains of Acinetobacter banmannii were detected.The infection rate had no relation with sex,which were more frequent in autumn,geriatric patients and ICU.The result of drug sensitive test showed that there was microvariation tendency of resistance rates to cefepime and cefotaxime,lowered to levofloxacin,ceftazidime,cotrimoxazole and aminoglycosides(gentamicin,tobramycin and amikacin),and the resistance was increased to piperacillin/ tazabactam,imipenem and meropenem during the past 3 years.Conclusions: The infection of Acinetobacter baumannii with acute respiratory tract infection is closely related to season,age and department in our hospital.Susceptibility results show that it is necessary to choose the antibiotics sensitive to Acinetobacter banmannii with multi-drug resistance according to the clinical distribution and the result of drug sensive test.