肝病患者不动杆菌的增长趋势及临床治疗选择  

The increase tendency and treatment options of Acinetobacter in clinical patients with liver diseases

作　　者：崔恩博[1] 鲍春梅[1] 张鞠玲[1] 王欢[1] 陈素明[1] 张成龙[1] 贾天野[1] 曲芬[1] 

机构地区：[1]解放军第302医院临床检验医学中心,北京100039

出　　处：《中国抗生素杂志》2014年第12期946-950,共5页Chinese Journal of Antibiotics

基　　金：解放军第302医院院内课题<不动杆菌流行病学及耐药研究(YNKT2012027)>

摘　　要：目的了解肝病患者不动杆菌的流行特征及耐药状况,为临床合理选用抗菌药物、有效控制医院感染提供依据。方法对2007—2011年间从我院分离自肝病患者的216株不动杆菌的流行状况及药敏结果进行分析,回顾治疗效果,提出临床治疗选择。结果 5年间不动杆菌感染逐渐增加,以鲍曼不动杆菌最多(79.17%);科室分布以重症监护病房(ICU)为主(54.17%);分离标本包括痰液(62.5%),血液(13.9%)和腹水(12%);该菌对多黏菌素B(3.6%)和米诺环素(15.66%)耐药率较低,对其他抗生素的耐药率分别为:头孢曲松71.30%、头孢哌酮78.24%、头孢哌酮/舒巴坦55.69%、替卡西林73.61%、左氧氟沙星57.0%、美罗培南51.5%、复方磺胺甲噁唑68.98%,多重耐药的比率髙达66.74%。复合抗生素组和碳青霉烯类组治疗的有效率分别为60.4%和62.0%。结论不动杆菌在肝病患者的分离呈逐年递升的趋势,耐药及多重耐药率较高,复合抗生素组和碳青霉烯类组可作为临床治疗的选择。Objective To investigate the epidemic feature and drug resistance of nosocomial Acinetobacter in patients with liver disease, for providing the data of antibiotics application and controlling of hospital infection. Methods The prevalence and drug sensitivity of 216 strains of Acinetobacter isolated from patients with liver diseases during 2007-2011 years were analyzed and treatment effects were retrospective reviewed for proposing treatment options. Results Among 5 years, the number of Acinetobacter was increasing gradually and Acinetobacter baumanii was the highest frequency （79.17%） in Acinetobacter genus, which distributed in intensive care unit （ICU） of departments mostly（54.17%）. Acinetobacter was mainly isolated from sputum specimens（62.5%）, followed by blood（13.9%） and ascites（12%）. The lower drug resistance rate of A cinetobacter produced in polymyxin B （3.6%） and Mino prostacyclin（15.66%）, and higher resistant rate happened to ceftriaxone（71.30%）, cefoperazone（78.24%）, cefoperazone/sulbactam（55.69%）, ticarcillin（73.61%）, levofloxacin（57.0%）, meropenem（51.5%） and trimethoprim/ sulfamethoxazole（68.98%）. The rate of multi-drug resistance reached 66.74%. The treatment efficiencies were 60.4% and 62% in comprisedβ-1actamase antibiotics and carbapenems respectively. Conclusion The prevalence of Acinetobacter nosocomial has been ascending gradually and resistant and multiple resistant is severe in liver diseases patients. The comprised β-lactamases antibiotic and carbapenems may be effective choices for clinical treatment.

关 键 词：肝病患者 不动杆菌 耐药 治疗 

分 类 号：R378[医药卫生—病原生物学]