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出 处:《重庆医学》2016年第35期4992-4994,4997,共4页Chongqing medicine
摘 要:目的分析鲍曼不动杆菌的分布特点、耐药性,以及耐碳青霉烯鲍曼不动杆菌(CRAB)感染的危险因素。方法对2013年10月至2015年10月该院临床分离的235株鲍曼不动杆菌进行药敏试验,按照2013年美国临床实验室标准化协会(CLSI)标准进行判读,并进行回顾性分析。结果鲍曼不动杆菌检出最多的为重症监护室(ICU),占53.19%;检出鲍曼不动杆菌的标本以痰液标本为主,占89.36%;鲍曼不动杆菌的耐药率较高,其对亚胺培南、头孢吡肟、头孢他啶及哌拉西林/他唑巴坦的耐药率分别为70.33%、73.21%、75.12%和66.03%;CRAB对碳青霉烯类、头孢菌素类和青霉素类的耐药率均高达100.00%;对哌拉西林/他唑巴坦、氨苄西林/舒巴坦等β内酰胺类/酶抑制剂复方制剂的耐药率也超过90%;感染CRAB的危险因素主要有入住ICU、联用过抗菌药物及使用呼吸机(P<0.05)。结论鲍曼不动杆菌对常用抗菌药物呈现不同的耐药性,临床应结合患者的临床表现、药敏试验结果及抗菌药药代动力学(PK)/药效动力学(PD)特点制订个体化的治疗方案,减少耐药菌株的产生。Objective To analyse the characteristics of distribution and drug resistance of Acinetobacter baumannn,and to explore risk factors of carbapenem-resistant Acinetobacter baumannii(CRAB) causing nosocomial infections. Methods The drug sensitivity test was performed for the 235 strains of Acinetobacter baumannii isolated from clinical specimens,from October 2013 to October 2015. The results were determined according to CLSI document,and were retrospectively analyzed. Results The largest number of Acinetobacter baumannii strains was isolated from the intensive care unit (ICU),accounted for 53.19%. And most of Acinetobacter baumannii strains were isolated from sputum specimens,accounted for 89.36 %. The rates of drug resistance of Acinetohacter haumannii to imipenem, cefepime, ceftazidime and piperacillin/tazobactam were 70.33 %, 73.21%, 75.12 % and 66.03 %, respectively. The rates of drug resistance of CRAB to carbapenems, cephalosporins and penicillins all were up to 100.00 %,and rate of drug resistance of CRAB to β-1actam/β-lactamase inhibitor combination, such as piperacillin/tazobactam and ampicillin/sulbactam, was also exceed 90 %. The risk factors of CRAB causing nosocomial infections were admission to ICU, combined use of antimicrobial agents and application of breathing machine(P〈0.05). Conclusion Strains of Acinetobacter baumannii show different resistance to commonly used antimicrobial agents. Rational use of antimicrobial agents should be based on patients' clinical manifestations, results of drug sensitivity test and PK/PD characteristics of antimicrobials, so as to reduce drug resistance.
关 键 词:鲍曼不动杆菌 抗菌药物 耐碳青霉烯鲍曼不动杆菌 耐药性
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