多重耐药鲍曼不动杆菌耐药性及感染病例分析  

Resistance and infection case analysis for multidrug-resistant Acinetobacter baumannii

作　　者：徐小用[1] 苏建荣[1] 

机构地区：[1]首都医科大学附属北京友谊医院临床检验中心,100050

出　　处：《中华检验医学杂志》2013年第8期748-751,共4页Chinese Journal of Laboratory Medicine

基　　金：首都医学发展基金资助项目（2009-1031）

摘　　要：目的分析微生物室菌库中多重耐药鲍曼不动杆菌（MDRAb）的耐药性及其相关病例。方法回顾性分析。选取2008年2至8月北京友谊医院住院患者中分离的38株多重耐药饱曼不动杆菌及其药敏结果；PCR法检测随机筛选出的非重复38株MDRAb耐药基因，核查其中37株MDRAb所属患者病历资料，另1株因病历资料被借出无法统计。结果ICU的MDRAb耐药率最高，其中对常用抗不动杆菌药物中的头孢类如头孢他啶、头孢曲松，氨基糖苷类如庆大霉素、环丙沙星以及碳青霉烯类美罗培南、亚胺培南100％（37／37）耐药；舒巴坦联合B内酰胺酶抑制剂比B内酰胺酶抑制剂单用更具敏感性；PCR证实全部MDRAb基因组中均携带OXA-23及OXA一51；病历提示MDRAb感染患者以老年患者居多，其中70—79岁所占比重最大，达46％，老年患者基础疾病多，免疫力低下，接受创伤性操作以及多种抗生素治疗，预后不良。结论ICU的MDRAb耐药率高，治疗具体病患的同时应防范暴发流行；本地区MDRAb耐药机制与OXA-23密切相关；对于临床MDRAb感染患者联合用药治疗很有必要，其中舒巴坦起重要作用；老年且基础疾病多的患者尤其注意提高其免疫力、减少侵入性操作以及合理使用抗生素。Objective To investigate the resistance and infection case for the Muhidrug-Resistant Acinetobacter baumanii （MDRAb） strains. Methods Retrospective study. Thirty-eight MDRAb strains were collected in Beijing Friendship Hospital from February to August 2008. VITEK2-compact system was used to detect the MDRAb. PCR was carried out to detect their resistance related genes and look up the medical records those who were infected by MDRAb. Results The resistance rate of the MDRAb is the highest in ICU. PCR confirmed that OXA-23 and OXA-51 were 100% related with the MDRAb. Combination drug therapy such as sulbaetam eombined with [3-1actam antibiotics was more effective than 15-lactam antibiotics only to treat the infeetion with MDRAb. Cases analysis showed that a number of patients infected by MDRAb were the aged with basic diseases, low immunity, received a variety of antibiotic therapy even traumatic operation, and they had a poor prognosis finally. Conclusions The resistance rate of the MDRAb is the highest in ICU, OXA-23 is closely related to muhidrug-resistance. Combination drug therapy is necessary and sulbactam can play a great role in curing the inpatients infected with MDRAb.

关 键 词：鲍氏不动杆菌 抗药性 多种 细菌 不动杆菌感染 药物疗法 联合 

分 类 号：R446.5[医药卫生—诊断学]