目的:探讨重症监护病房(ICU)鲍曼不动杆菌(Aba)感染的危险因素及耐药性特点,为临床合理用药提供参考.方法:收集2012年1月至2015年10月在本院ICU住院治疗并检出Aba感染的272例患者作为研究对象,并对分离的病原菌分布及耐药性进行统计分析.结果:Aba感染的危险因素包括基础疾病、侵入性操作、使用抗菌药物与其他危险因素等方面,构成比排在前5位的因素分别是抗菌药物使用时间≥7 d(69.1％)、格拉斯哥昏迷指数(GCS)＜8分(66.5％)、气管插管/切开(64.0％)、使用第三代头孢菌素(59.6％)和年龄≥60岁(58.5％).抗菌药物的用药频度排在前5位的药物分别是亚胺培南(1664.0)、萘夫西林(1608.0)、头孢匹胺(1568.0)、左旋氧氟沙星(926.0)和哌拉西林(602.0).体外药敏试验结果显示272株Aba对抗菌药物的耐药现象严重,仅对阿米卡星(78.3％)较为敏感,耐药率排在前5位的药物分别是头孢替坦(98.5％)、头孢唑啉(97.4％)、氨曲南(87.9％)、美洛培南(86.5％)和环丙沙星(80.9％).结论:Aba对常用抗菌药物的耐药现象严重,ICU病区应加强对Aba的实时监测和预防控制,并根据药敏结果选择合适的抗菌药物,避免抗生素滥用以减少耐药株的产生.%Objective:To investigate the distribution and drug resistance of Acinetobacter baumannii(Aba) in intensive care unit(ICU),so as to guide clinical treatment.Methods:A.baumannii were isolated and cultured from 272 patients with Aba infection in our hospital ICU from Jan.,2012 to Oct.,2015,and pathogen distribution and drug resistance were analyzed.Identification of isolated pathogens and drug sensitivity analysis were performed using VITEK 2 Compact Microbiology Analysis System.Results:The risk factors for A.baumannii infection included underlying diseases,invasive procedures,use of antimicrobial agents and other risk factors.The top 5 risk factors were treated with antibiotics≥7 d(69.1％),Glasgow coma scale (GCS)＜8 (66.5％),tracheal intubation/incision (64.0％),third-generation cephalosporins(59.6％) and age≥60 years old(58.5％).Antibiotic drug frequency of the top five drugs were imipenem(1664.0),nafcillin(1608.0),cefpiramide(1568.0),levofloxacin(926.0) and piperacillin (602.0).Results of drug sensitivity test in vitro showed that Aba resistance to antimicrobial drugs was serious.The top 5 resistant rate were cefotetan(98.5％),cefazolin(97.4％),aztreonam(87.9％),meropenem(86.5％) and ciprofloxacin(80.9％).Conclusion:A.baumannii is a main opportunistic pathogen causing nosocomial infections with strong drug resistance and wide drug resistance spectrum.We should pay more attention for monitoring and preventing multidrug resistance of A.baumannii.
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