2014年某综合性医院多药耐药鲍曼不动杆菌的耐药现状及临床分布

摘要

目的：调查多药耐药鲍曼不动杆菌（MDRAB）的耐药现状及临床分布特征，为临床成功治疗MDRAB感染，制订有效的防控措施提供依据。方法回顾性分析2014年1～12月某院275例鲍曼不动杆菌（AB）感染患者所在病区、感染标本类型、感染发生时间、性别、年龄等有关因素，并分析MDRAB耐药率。结果共检出MDRAB菌株123株，占检出AB菌株的44．73％；123株MDRAB对15种常用抗菌药物中的12种耐药率达90％以上，仅对米诺环素耐药率（19．23％）较低；AB及MDRAB呈现病区集中分布趋势，重症监护室（ICU ）、呼吸内科及神经外科为主要感染病区；痰液标本来源的 AB及 MDRAB分别占84．00％、93．50％；MDRAB感染率在全年12个月无明显变化；不同性别、年龄段患者感染非MDRAB与MDRAB的构成比比较，差异均无统计学意义（P＞0．05）。结论 MDRAB对常用抗菌药物的耐药情况严重，米诺环素仍可作为临床治疗MDRAB的重要抗菌药物，加强ICU、呼吸内科、神经外科等重点病区，以及呼吸道、创口等MDRAB重点感染部位的感控管理，对降低MDRAB感染风险有重要意义。%Objective To investigate the drug resistance situation and clinical distribution of multi‐drug resistance Acinetobacter baumannii(MDRAB) ,in order to provide references for clinical treatment and prevention of MDRAB infection .Methods The de‐partments ,types of specimens ,time of infection ,gender and age of patients with Acinetobacter baumannii(AB)infection from Janu‐ary to December 2014 were retrospectively analysed ,and drug resistance rates of MDRAB were analysed as well .Results A total of 123 strains of MDRAB were isolated ,which accounted for 44 .73% of all strains of AB .The antibacterial resistance rates were over 90% for MDRAB against 12 out of 15 common antibacterial agents ,while the antibacterial resistance rate for MDRAB against mi‐nocycline was relatively low(19 .23% ) .Distribution of AB and MDRAB infection concentrated to certain departments ,which shown that intensive care unit(ICU) ,departments of respiratory medicine and neurosurgery were the major departments of infection .The strains of AB and MDRAB isolated from sputum specimens accounted for 84 .00% and 93 .50% respectively .There was no signifi‐cant differences of MDRAB infection among 12 Months in 2014 .There was no statistically significant differences in constituent ratio of MDRAB infection and non‐MDRAB infection between patients in different gender and between patients in different age groups . Conclusion MDRAB strains are seriously resistant to commonly used antibacterial agents ,while minocycline could still be a signifi‐cant antibacterial agent for clinical treatment of MDRAB infection .Strengthening infection management in ICU and departments of respiratory medicine and neurosurgery ,and infection management of respiratory tract and wound could have significance for reduc‐ing the risk of MDRAB infection .