鲍曼不动杆菌耐药性研究

目的:了解河北省临床分离的鲍曼不动杆菌的耐药情况,及时监测其耐药现状,为临床治疗提供合理的指导和参考。方法:收集了2004年1月～2008年7月河北省二院(43株)、河北省三院(6株)、河北省四院(2株)、唐山工人医院(12株)、沧州中心医院(11株)、石家庄市医院(8株)、邢台市人民医院(5株)、徐水市医院(3株)临床分离的不同来源的90株鲍曼不动杆菌,分析了菌株的标本来源和医院科室分布情况;测定了美罗培南等7种抗生素的MICs值;结果:(1)90株鲍曼不动杆菌中,来源于痰标本最多,为82株,占91.2%;其他标本依次为分泌物3株(3.3%),尿液2株(2.2%),耳分泌物、脓液、咽拭子各1株,均占(1.1%)。(2)90株鲍曼不动杆菌中,从ICU患者分离的菌株最多,为30株,占33.2%;其他依次为呼吸内科18株(20.0%)、神经外科病房7株(7.8%)、急诊科6株(6.7%)。(3)MICs测定结果:90株鲍曼不动杆菌中,81株对一种及以上抗生素耐药,耐药率为90.0%(81/90),69株对三种以上生素耐药,耐药率为76.7%(69/90)。其中美罗培南(MEM)、亚胺培南(IPM)敏感率分别为58.9%、51.1%,头孢哌酮/舒巴坦(CFP/SB)敏感率为30.0%、左氧氟沙星(LVLX)敏感率为21.1%、哌拉西林/他唑巴坦(TZP)敏感率20.0%、阿米卡星(AKN)、头孢他啶(CAZ)敏感率分别为16.7%和15.6%。结论:(1)多个科室患者均可受鲍曼不动杆菌的感染,以ICU患者感染率最高;鲍曼不动杆菌可引起病人多部位感染,以呼吸道感染率最高。(2)鲍曼不动杆菌中耐药率很高,且多呈多重耐药。在临床常用的7种抗菌药物中,无一种能完全抑制鲍曼不动杆菌,其中美罗培南和亚胺培南敏感率较高,而头孢他咤和阿米卡星耐药率较高。

Study on Antimicrobial Resistance of Acinetobacter Baumannii

Objective:In this study,the antimicrobial resistance and molecular mechanisms of Acinetobacter baumannii isolated from eight hospitals in Hebei province were investigated,which would provide a reasonable basis for clinical therapy.Methods:Ninety A.Baumanii isolates were collected from 8 hospitals in Hebei Province during January 2004 to July 2008(43 from the Second Hospital of Hebei Medical University,6 from the third Hospital of Hebei Medical University,2 from the fourth Hospital of Hebei Medical University, 12 from Tangshan Worker’ s Hospital,11 from Cangzhou Central Hospital,8 from Shijiazhuang City Hospital,5 from Xingtai City People’s Hospital,and 3 from Xushui City Hospital).The department distribution and specimen source of Acinetobacter Baumanii isolates were analyzed,and the MICs of 7 antibiotics were detected using the standard broth microdilution method.Results:(1) About 91.2% (42/90) of A.baumanii were isolated from sputum samples,3.3%(3/90) from secretion samples,and 2.2%(2/90) from urine.(2) More than 33%(30/90) of A.baumanii were distributed in Intensive Care Unit(ICU),20%(18/90) in department of respiratory,7.8%(7/90) in neurosurgery wards,and 6.7%(6/90) from emergency department.(3) About 90.0%(81/90) of A.baumanii were resistant to more than one antimicrobial,and 76.7%(69/90) were resiatant to more than three antimicrobials.The sensitivity rate of A.baumanii to MEM,IPM,CFP/ SB,LVLX,TZP,AKN,and CAZ was 58.9%,51.1%,30.0%,21.1%,20.0%,16.7%and 15.6%,respectively.Conclusion:(1)The patients who were infected by A.baumanii distributed in many departments,and among of therm,ICU patients had the highest infection rate. Multiple organs could be infected by A.baumanii,while the respiratory infection rate was the highest.(2) A.baumanii were highly resistant to antibiotics,and most of them were multidrug resistant.The sensitivity rates to MEM and IPM were higher than other clinical antibiotics, while the resistant rates to CAZ and AKN were the highest..