多重耐药鲍曼不动杆菌下呼吸道感染的临床特点及药敏分析

摘要

Objective To analyze the clinical characteristics of lower respiratory tract infection caused by multidrug resistant Acinetobacter Baumannii and to investigate the antibiotic sensitivity of acinetobacter baumannii strains. Methods The clinical data of 162 cases with lower respiratory tract infection by multidrug resistant Acineto-bacter Baumannii were retrospectively analyzed. Drug sensitivity against strains of multidrug resistant Acinetobacter Baumannii was tested by K-B method. Results 97. 5% of the cases had underlying diseases, most of which were COPD complicated with respiratory failure. 93. 8% of the cases were immunocompromised. 79% of the cases were in ICU. 79% of the cases accepted invasive treatments, and 98. 7% of the cases were given broad-spectrum antibiotics. Their clinical manifestations include chill (58. 1%), fever (98. 8%), cough (95. 1%) and expectoration (93. 8%). The chest computed tomography revealed infiltration in lower lobes of both lungs, and 24 cases were complicated with pleural effusions. The drug sensitivity test in vitro showed that these strains were multiresistant to commonly used anti-biotics, and drugs whose sensitive rate were over 50% included Tigecycline, and Polymyxin B. Conclusion The lower respiratory tract infection caused by multidrug resistant acinetobacter baumannii develops in patients with various under-lying diseases, especially in the immunocompromised patients. The risk factors of morbidity are patients in ICU, ac-ceptance of invasive treatment and inappropriate use of broad-spectrum antibiotics. The clinical manifestations include severely toxic symptoms and some cases have pulmonary consolidations and pleural effusions.%目的 分析和总结我院多重耐药鲍曼不动杆菌下呼吸道感染的临床特点及抗生素敏感性的分布情况.方法 对162例多重耐药鲍曼不动杆菌下呼吸道感染的临床资料进行统计分析,采用纸片法(Kir-by-Bauer)测定该菌的体外药物敏感性.结果 162例中97.5%(158/162)患有基础疾病,其中慢性阻塞性肺疾病(慢阻肺)、脑血管疾病最常见.93.8%(158/162)的患者免疫功能低下,79.0%(128/162)入住ICU病房,79%(128/162)曾接受侵入性治疗,98.7%(159/162)前期使用过广谱抗生素.临床表现为畏寒(58.1%)、发热(98.8%)、咳嗽(95.1%)、咳痰(93.8%),胸部CT多表现为双下肺淡薄、斑片状阴影.药敏监测表明该菌广泛耐药,敏感率>50%者仅有替加环素、多粘菌素B.结论 多重耐药鲍曼不动杆菌下呼吸道感染多发生在患有各种基础疾病、免疫功能低下者.临床表现感染中毒症状明显,细菌耐药现象严重,诊断与治疗有赖于细菌培养和药物敏感结果.