重症监护室多重耐药鲍曼不动杆菌感染调查  

Investigation of multidrug-resistant acinetobacter baumanniiinfection in ICU

作　　者：罗钰填 赵颖 洪澄英 刘雪燕 LUO Yutian;ZHAO Ying;HONG Chengying;LIU Xueyan(Department of Critical Medicine,Shenzhen People’s Hospital,Shenzhen,Guangdong 518000,China)

机构地区：[1]深圳市人民医院重症医学科,广东深圳518000

出　　处：《安徽医药》2021年第1期187-190,共4页Anhui Medical and Pharmaceutical Journal

基　　金：深圳市卫生计生系统科研项目(201607019)。

摘　　要：目的调查重症监护室(ICU)病房多重耐药鲍曼不动杆菌感染情况,并提出预防建议。方法选取深圳市人民医院ICU病房2017年1—12月自病人的痰标本、尿液标本等,医护人员手、环境物品等中分离出的41株多重耐药鲍曼不动杆菌,统计标本来源;采用纸片扩散法进行药敏试验;采用脉冲场凝胶电泳方法分析其同源性。结果痰标本占比最高,为19.51%,其次为肺泡灌洗液、腹腔引流液、胸腔引流液,尿液、胆汁、血液,床旁彩超机、床边X光机、转运床、床边心电图机,医护人员手,床栏;本研究中菌株对头孢曲松的耐药率较高,为95.12%,对头孢他啶、哌拉西林、亚胺培南、美罗培南、环丙沙星等的耐药率也较高,均为73.17%,对复方磺胺甲唑、米诺环素的敏感率分别为31.71%、34.15%,而对其余常用抗生素的敏感率均低于30%;所选多重耐药鲍曼不动杆菌经脉冲场凝胶电泳方法检测显示共分为6个型,分别命名为A型、B型、C型、D型、E型、F型,分别有14株、7株、7株、7株、4株、2株,占比分别为34.15%、17.07%、17.07%、17.07%、9.76%、4.88%。结论ICU病房多重耐药鲍曼不动杆菌来源广,对常用抗生素的耐药率高;应根据同源性检测结果制定预防策略并加大防控力度。Objective To investigate the situation of multidrug-resistant Acinetobacter Baumannii infection in intensive care unit(ICU),and put forward preventive suggestions.Methods A total of 41 strains of multidrug-resistant Acinetobacter baumannii were isolated from sputum specimens,urine specimens and medical staff’s hands,environmental objects,etc of patients in the ICU ward of the Shenzhen People’s hospital from January to December 2017.The statistical sources of the samples were collected.The drug sensitivity test was carried out by disk diffusion method,and the homology of them was analyzed by pulsed field gel electrophoresis.Results Sputum samples accounted for the highest proportion(19.51%),followed by alveolar lavage fluid/peritoneal drainage fluid/thoracic drainage fluid,urine/bile/blood,bedside color ultrasound machine/bedside X-ray machine/transfer bed/bedside electrocardiograph,medical staff hands,bedside bars.In this study,the resistance rate of ceftriaxone was 95.12%.The resistance rates of ceftazidime,piperacillin,imipenem,meropenem and ciprofloxacin were 73.17%.The sensitivity rates to compound minocycline and minocycline were 31.71%and 34.15%,respectively.However,the sensitivity rate to other commonly used antibiotics is less than 30%.The detection of multidrug resistant Acinetobacter by pulsed field gel electrophoresis showed that there were 6 types,named A,B,C,D,E and F respectively,14 strains,7 strains,7 strains,7 strains,4 strains and 2 strains,accounting for 34.15%,17.07%,17.07%,17.07%,9.76%and 4.88%respectively.Conclusions The multidrug resistant Acinetobacter Baumannii in ICU ward has a wide range of sources and high resistance rate to com1 monly used antibiotics,and preventive strategies should be formulated and strengthened according to the results of homologous detection.

关 键 词：鲍曼不动杆菌 抗药性 细菌 抗药性 多药 重症监护室 序列同源性 预防 

分 类 号：R446.5[医药卫生—诊断学]