耐碳青霉烯鲍曼不动杆菌临床及药敏情况  

Clinical characteristics and susceptibility of carbapenem-resistant Acinetobacter baumannii

作　　者：林家福[1] 刘永芳[1] 曾跃[1] 王贵霞[1] 冀一帆 于毅[1] 张廷君[1] 孟黄花[1] 

机构地区：[1]川北医学院附属医院,南充637000

出　　处：《中国抗生素杂志》2014年第2期141-145,共5页Chinese Journal of Antibiotics

基　　金：四川省教育厅科研项目(No.11ZB164)

摘　　要：目的调查耐碳青霉烯鲍曼不动杆菌(carbapenem-resistant Acinetobacter baumannii,CR-AB)感染者临床特征及对抗菌药物敏感情况。方法收集川北地区两家三甲医院微生物室分离的临床感染患者的90株非重复CR-AB菌株,采用琼脂对倍稀释法对15种临床常用抗菌药物进行体外抗菌活性测定,并回顾性分析其临床资料。结果 90株CR-AB标本类型两家医院均以痰液为主,各占74%(37/50)和70%(28/40),其次是分泌物,各占18%(9/50)和25%(10/40);分布科室两家医院均以重症监护室(ICU)、神经外科、呼吸内科最为常见。90例感染者基础疾病以颅脑疾病和慢性阻塞性肺疾病(COPD)为主;感染CR-AB前多有入住ICU史、人工气道、机械通气、侵入性操作、手术以及使用多种抗菌药物或碳青霉烯类抗菌药物等。90株CR-AB对多黏菌素B、米诺环素、头孢哌酮/舒巴坦、哌拉西林/三唑巴坦耐药率分别为0、20.0%、28.9%和86.7%,对其它抗菌药物耐药率均为100%,部分药物MIC90值≥512μg/mL。结论对碳青霉烯类耐药的鲍曼不动杆菌对其它常用抗菌药物耐药严重,多黏菌素B、米诺环素、头孢哌酮/舒巴坦可作为治疗药物选择。Objective To investigate the clinical characteristics of carbapenem-resistant Acinetobacter baumannii（CR-AB） infected persons and sensitivity to antimicrobial agents. Methods A total of non-repetitive 90 strains of CR-AB were isolated from clinical specimens of two three-level hospitals in north Sichuan. The MICs of 15 antimicrobial agents were evaluated by double-agar dilution method, and their clinical data was retrospectively analyzed. Results Sputum was the main source of specimen of the 90 strains and followed by secretions. There were 74%（37/50）, 70%（28/40） for sputum and 18%（9/50）, 25%（10/40） for secretions respectively in the two hospitals. 90 strains of CR-AB was mainly distributed in the intensive care unit（ICU） neurosurgery and pneumology department. The underlying diseases were usually craniocerebral disease and chronic-obstructive disease （COPD） in the 90 patientes. ICU admission, artificial airway, mechanical ventilation, aggressive procedures, operation and treating with multiple antibiotics or Carbapenem antibiotics could be found in most patients before infection. The resistancerates to polymyxinB, minocycline, cefoperazone/sulbactam, and piperacillin/tazobactam were 0, 20.0%, 28.9% and 86.7% respectively. The resistant rates was 100% to other commonly used drugs, and the MIC90≥ 512μg/mL of some drugs. Conclusion The drug resistance of carbapenem-resistant Acinetobacter baumannii is serious; The polymyxinB, minomycin and cefoperazone/sulbactam with considerable antibacterial activities may be the choices for Carbapenem- resistant isolates infections ofAcinetobacter baumannii.

关 键 词：鲍曼不动杆菌 耐碳青霉烯 治疗 

分 类 号：R978.1[医药卫生—药品]