重症监护病房多重耐药鲍曼不动杆菌感染及耐药性分析

摘要

目的 对北京友谊医院重症医学科(ICU)中2011至2013年检出的多重耐药鲍曼不动杆菌进行感染及耐药性分析,为临床预防及合理使用抗生素,控制鲍曼不动杆菌感染提供依据.方法 回顾性研究.共收集2011年1月至2013年12月从ICU患者中分离出的多重耐药鲍曼不动杆菌185株,使用Vitek-2 Compact全自动微生物分析系统进行菌株鉴定及药物敏感性分析,并按年度统计其感染率.使用PCR方法对菌株进行耐药基因进行抽样检测.分析感染多重耐药鲍曼不动杆菌患者的临床特征,并与没有感染患者的平均年龄、平均急性生理与慢性健康(APACHE)Ⅱ评分、平均住ICU时间及ICU内死亡率进行对比.患者年龄、住ICU时问及APACHEⅡ评分使用秩和检验进行分析,ICU内死亡率及年度感染率的比较使用x2检验进行分析.结果 感染多重耐药鲍曼不动杆菌患者的平均年龄[(67±l7)和(59±19)岁,Z=-5.365,P=0]、APACHEⅡ评分[(25.68±7.93)和(17.62 ±8.39)分,Z=-14.821,P=0]、平均住ICU时间[(27±29)和(5±8)d,Z=-4.342,P=0]及ICU内死亡率[10.82％(53/185)和28.65％ (147/1 359),x2=45.92,P=0]均明显高于未感染者;多重耐药鲍曼不动杆菌在痰及支气管吸出物检出率最高,占83.78％(155/185);与2011年相比,2013年其检出率明显降低[11.07％ (69/469)和8.37％ (52/621),x2=8.755,P=0.003],但耐药率未见明显改变.耐药菌均可检出OXA-23及OXA-51基因.结论 ICU中多重耐药鲍曼不动杆菌的耐药机制与OXA-23基因密切相关.对高龄、重症的肺炎患者,应更加积极地防控多重耐药鲍曼不动杆菌感染,加强消毒、隔离措施可使多重耐药鲍曼不动杆菌检出率降低,对已感染的患者需应用联合方案进行抗感染治疗.%Objective In order to prevent the infection of Acinetobacter baumannii and use antibiotics rationally,the clinical infection and drug resistant data of multi-drug resistance Acinetobacter baumannii (MRAB)detected in intensive care unit (ICU)of Beijing Friendship Hospital from 2011 to 2013were analyzed.Methods This study is a retrospective study.One hundred and eighty five strains of MRAB were collected from the patients in ICU from January 2011 to December 2013.Identificationand antibiotic susceptibility of strains were determined with Vitek-2 Compact automatic bacteria identification system.The annual infection rate of MRAB was counted.PCR was used to detect the resistance genes.The clinical features of the patients with MRAB were analyzed.The average age,acute physiology and chronic health evaluation (APACHE) Ⅱ score,duration in ICU and mortality ratio of the MRAB patients were compared with the patients without MRAB.Rank-sum test was used to analyze the average age,APACHE Ⅱ score and duration in ICU.Chi-squared test was used to analyze the mortality ratio and annual infection rate.Results The average age [(67 ± 17)vs (59-± 19) years old,Z =-5.365,P =0],APACHE Ⅱ score [(25.68±7.93) vs (17.62±8.39),Z=-14.821,P=0],duration in ICU [(27 ±29) vs (5 ±8) d,Z =-4.342,P =0] and mortality ratio [10.82％ (53/185) vs 28.65％ (147/1 359),x2 =45.92,P =0] of the patients infected by MRAB were significantly higher than those without the infection.The MRAB was found mostly in sputum and bronchial precipitates (83.78％,155/185).Though detection rate reduced yearly and there was a significant reduction in 2013 compared with 2011 [11.07％ (69/469) vs 8.37％ (52/621),x2 =8.755,P =0.003],the drug resistant rate was in high level and did not show any change in the 3 years.OXA-23 and OXA-51 were detected in all MRAB.Conclusions The main drug resistant mechanism of MRAB in ICU is related to OXA-23.More active methods of coutrol and prevention of MRAB should be used in elderly aud severely pneumonic patients.Intensive disinfection and isolation measures can decrease MRAB detection rate.Combined antibiotics should be used in patients with MRAB infection.