MICU患者痰中检出泛耐药鲍氏不动杆菌的分析  

Pathogenicity of pandrug-resistant Acinetobacter baumannii isolated from sputum of MICU patients

作　　者：王丽丹[1] 龙晓凤[1] 刘海梅[1] 吕明义[1] 邓淑玲[1] 

机构地区：[1]大连大学附属中山医院内科重症监护室,辽宁大连116001

出　　处：《中华医院感染学杂志》2013年第24期6123-6125,共3页Chinese Journal of Nosocomiology

基　　金：辽宁省博士启动基金资助项目(2011102)

摘　　要：目的探讨内科重症监护病房(MICU)住院患者痰液中检出泛耐药鲍氏不动杆菌致病性,为临床资料提供参考依据。方法回顾性分析2010年11月-2012年11月入住MICU的24例患者临床资料,共分离出24株泛耐药鲍氏不动杆菌,均取自患者痰液;采用K-B纸片法对其耐药性进行分析;采用脉冲场凝胶电泳法对其同源性进行分析;采用病例流行病学分析患者肺部感染的发生情况等,数据采用SPSS16.0软件进行统计分析,计数采用χ2检验。结果 24株泛耐药鲍氏不动杆菌对常用的抗菌药物敏感率,最高为阿米卡星62.50%,其次为二甲胺四环素50.00%、庆大霉素20.83%、头孢吡肟16.67%等,对他唑巴坦、哌拉西林、舒巴坦、头孢噻肟、亚胺培南、美罗培南及头孢哌酮等敏感率均较低;同源性分析显示,A基因型10株、B基因型4株、J基因型3株,其他基因型分别为C、D、E、F、G、H、I基因型各1株;A基因型泛耐药鲍氏不动杆菌感染患者发生肺部感染的比率为62.50%,明显高于B型肺部感染率的25.00%,二者差异有统计学意义(P<0.01)。结论 24株泛耐药鲍氏不动杆菌对常用抗菌药物具有较高的耐药率,A基因型泛耐药鲍氏不动杆菌的致病性最强,应加强对其进行预防与控制。OBJECTIVE To explore the pathogenicity of pandrug-resistant Acinetobacter baumannii isolated from the sputum of the patients of medicine intensive care unit （MICU） so as to provide evidence for the clinical data. METHODS The clinical data of 24 patients who were hospitalized the MICU from Nov 2010 to Nov 2012 were retrospectively analyzed, totally 24 strains of pandrug-resistant A. baurnannii have been isolated from the sputum; the drug resistance was analyzed with the use of K-B method, the homology was analyzed by using the pulsed-field gel electrophoresis, the epidemiological analysis was performed for the incidence of pulmonary infections, all the data were statistically analyzed by using the SPSS16.0 software, and chi-square test was conducted for the analysis of measurement data. RESULTS Of totally 24 strains of pandrug-resistant A. baurnannii isolated, the drug susceptibility rate to amikacin was the highest （62. 50%）, followed by minocycline （ 50. 00%）, gentamicin （20.83%）, and cefepime （16.67%）, while the drug susceptibility rates to tazobactam, piperacillin, sulbactam, cefotaxime, imipenem, meropenem, and cefoperazone were relatively low. The result of homological analysis indicated that there were 10 strains of genotype A, 4 strains of genotype B, 3 strains of genotype J , 1 strain of genotype C, 1 strain of genotype D, 1 strain of genotype E, 1 strain of genotype F, 1 strain of genotype G, 1 strains of genotype H, and 1 strains of genotype I. The incidence rate of pulmonary infections in the patients with genotype A pandrug-resistant A. baumannii infections was 62. 50%, significantly higher than 25. 00% of the patients with the genotype B, the difference between the two was statistically significant （P 〈 0. 01 ）. CONCLUSION The 24 isolates of pandrug-resistant A. baumannii are highly resistant to the commonly used antibiotics, the pathogenicity of the genotype A pandrug-resistant A. baumannii is the most powerful, therefore the prevention and control of it should be enhanced.

关 键 词：内科重症监护病房 耐药率 致病性 泛耐药鲍氏不动杆菌 

分 类 号：R378[医药卫生—病原生物学]