86例ICU鲍曼不动杆菌耐药性分析(1)
摘 要 目的：分析ICU患者下呼吸道分泌物中分离出的鲍曼不动杆菌耐药性，为临床医师尽早合理选用抗菌药物提供依据。方法：回顾性分析2012年6月至2016年12月我院ICU不同住院时间分离出鲍曼不动杆菌对常用抗菌药物的耐药性。结果：本研究共纳入86例下呼吸道分泌物鲍曼不动杆菌分离阳性患者，共分离出94株鲍曼不动杆菌，其对头孢哌酮舒巴坦耐药率较低(14株)；对美罗培南(80株)、亚胺培南(74株)的耐药率较高；早发组和晚发组对常见抗菌药物耐药率无明显差异。结论：该ICU鲍曼不动杆菌对碳青霉烯类抗生素耐药率较高，晚发院内感染是否是细菌多重耐药的危险因素需进一步研究。
关键词 重症医学科 鲍曼不动杆菌 耐药性
中图分类号：R446.5； R515.9 文献标识码：B 文章编号：1006-1533(2018)05-0046-02
Analysis of the drug resistance of 86 cases of Acinetobacter baumannii isolated from ICU
ZHANG Raorao
(Department of ICU， No. 5 Affiliated Hospital of Zhengzhou University， Zhengzhou 450052， China)
ABSTRACT Objective： To provide a basis for clinicians to choose antibacterial agents as early as possible. Methods： The drug resistance of common antibacterial agents against Acinetobacter baumannii isolated from the lower respiratory tract secretions of ICU patients from June， 2012 to December， 2016 were retrospectively analyzed. Results： Eighty-six cases of positive patients were included and 94 strains of Acinetobacter baumannii were isolated， in which there were 14 strains resistant to cefoperazone sulbactam， 80 strains to meropenem， 74 strains to imipenem. There were no significant differences between the early and late onset groups in the resistance of common antibacterial agents against those isolates. Conclusion： There is higher incidence in the resistance of carbapenems against Acinetobacter baumannii， and whether or not late nosocomial infection is a risk factor for bacterial multidrug resistance needs to be further studied.
KEY WORDS ICU； Acinetobacter baumannii； drug resistance
鲍曼不动杆菌作为医院感染的重要病原菌，主要引起呼吸道的感染，因其对常用抗生素耐药率有逐年增加的趋势，成为医疗卫生机构日益增多的可怕的病原体[1]。鲍曼不动杆菌院内感染主要发生于ICU，具有较高的感染病死率[2]，尽早选用有效抗菌药物意义重大。2016年CHINT报告显示不同医院分离出的鲍曼不动杆菌对常用抗生素的耐药性差别巨大，其中对亚胺培南的耐药率范围为7.1%～92.4%[3]；本研究旨在通过对我院ICU患者下呼吸道分泌物分离出的鲍曼不动杆菌耐药性分析，为临床医师尽早合理经验性用药提供依据。
1 对象与方法
1.1 研究对象
对我院2012年6月至2016年12月ICU收治的气管插管患者下呼吸道分泌物培养出的鲍曼不动杆菌且病例资料完整的86例患者进行回顾性调查。病例入组标准：至少1次痰培养鲍曼不动杆菌阳性，并达到肺部感染的诊断标准。参照早发院内获得性肺炎(hospital acquired pneumonia， HAP)与晚发HAP的时间标准将患者分为早发组和晚发组；早发组：住院时间≤4 d下呼吸道分泌物分离出鲍曼不动杆菌。晚发组：住院时间>4 d下呼吸道分泌物分离出鲍曼不动杆菌。其中早发组22例，男18例，女4例，平均年龄(73.08±12.61)岁，急性生理与慢性健康评分(acute physiology and chronic health evaluation Ⅱ， APACHE Ⅱ)评分(19.37±5.45)；晚发组64例，男51例，女7例，平均年龄(70.17±13.4)岁，APACHE Ⅱ评分(18.93±6.57)；两组患者的年龄、性别构成、及APACHEⅡ评分差异无统计学意义(P>0.05)。
1.2 细菌鉴定及药物敏感试验
采用DL-96全自动细菌鉴定与药敏分析系统鉴定鲍曼不动杆菌并进行药敏分析。质控菌株为大肠埃希菌ATCC 25922、銅绿假单胞菌ATCC278530。
1.3 收集资料, 百拇医药(张娆娆)
关键词 重症医学科 鲍曼不动杆菌 耐药性
中图分类号：R446.5； R515.9 文献标识码：B 文章编号：1006-1533(2018)05-0046-02
Analysis of the drug resistance of 86 cases of Acinetobacter baumannii isolated from ICU
ZHANG Raorao
(Department of ICU， No. 5 Affiliated Hospital of Zhengzhou University， Zhengzhou 450052， China)
ABSTRACT Objective： To provide a basis for clinicians to choose antibacterial agents as early as possible. Methods： The drug resistance of common antibacterial agents against Acinetobacter baumannii isolated from the lower respiratory tract secretions of ICU patients from June， 2012 to December， 2016 were retrospectively analyzed. Results： Eighty-six cases of positive patients were included and 94 strains of Acinetobacter baumannii were isolated， in which there were 14 strains resistant to cefoperazone sulbactam， 80 strains to meropenem， 74 strains to imipenem. There were no significant differences between the early and late onset groups in the resistance of common antibacterial agents against those isolates. Conclusion： There is higher incidence in the resistance of carbapenems against Acinetobacter baumannii， and whether or not late nosocomial infection is a risk factor for bacterial multidrug resistance needs to be further studied.
KEY WORDS ICU； Acinetobacter baumannii； drug resistance
鲍曼不动杆菌作为医院感染的重要病原菌，主要引起呼吸道的感染，因其对常用抗生素耐药率有逐年增加的趋势，成为医疗卫生机构日益增多的可怕的病原体[1]。鲍曼不动杆菌院内感染主要发生于ICU，具有较高的感染病死率[2]，尽早选用有效抗菌药物意义重大。2016年CHINT报告显示不同医院分离出的鲍曼不动杆菌对常用抗生素的耐药性差别巨大，其中对亚胺培南的耐药率范围为7.1%～92.4%[3]；本研究旨在通过对我院ICU患者下呼吸道分泌物分离出的鲍曼不动杆菌耐药性分析，为临床医师尽早合理经验性用药提供依据。
1 对象与方法
1.1 研究对象
对我院2012年6月至2016年12月ICU收治的气管插管患者下呼吸道分泌物培养出的鲍曼不动杆菌且病例资料完整的86例患者进行回顾性调查。病例入组标准：至少1次痰培养鲍曼不动杆菌阳性，并达到肺部感染的诊断标准。参照早发院内获得性肺炎(hospital acquired pneumonia， HAP)与晚发HAP的时间标准将患者分为早发组和晚发组；早发组：住院时间≤4 d下呼吸道分泌物分离出鲍曼不动杆菌。晚发组：住院时间>4 d下呼吸道分泌物分离出鲍曼不动杆菌。其中早发组22例，男18例，女4例，平均年龄(73.08±12.61)岁，急性生理与慢性健康评分(acute physiology and chronic health evaluation Ⅱ， APACHE Ⅱ)评分(19.37±5.45)；晚发组64例，男51例，女7例，平均年龄(70.17±13.4)岁，APACHE Ⅱ评分(18.93±6.57)；两组患者的年龄、性别构成、及APACHEⅡ评分差异无统计学意义(P>0.05)。
1.2 细菌鉴定及药物敏感试验
采用DL-96全自动细菌鉴定与药敏分析系统鉴定鲍曼不动杆菌并进行药敏分析。质控菌株为大肠埃希菌ATCC 25922、銅绿假单胞菌ATCC278530。
1.3 收集资料, 百拇医药(张娆娆)