重症监护室耐亚胺培南鲍曼不动杆菌的耐药性分析

目的探讨温州医学院附属第一医院重症监护室（ICU）耐亚胺培南鲍曼不动杆菌的耐药特性。方法对2006年1月至2007年12月ICU分离的菌株采用常规方法进行菌株分离,经革兰染色、氧化酶试验等初筛,再经VITEK-32型全自动微生物分析仪进行菌株鉴定和药敏试验。结果共检测到98株鲍曼不动杆菌,其中耐亚胺培南的鲍曼不动杆菌为50株（占51.0%）,标本来源大部分为痰液（占94.9%）。耐亚胺培南鲍曼不动杆菌对常用16种抗菌药物耐药率〉50%的有15种,耐药率〉90%有3种,分别为氨苄西林（98.0%）、头孢唑林（99.0%）和呋喃妥因（99.0%）,对抗菌药物耐药率最低仅为头孢哌酮/舒巴坦（10.2%）,另外检测到对所用抗菌素泛耐为4株（8.0%）;而对亚胺培南敏感的鲍曼不动杆菌对常用16种抗菌药物耐药率〉50%的仅为4种,耐药率〉90%同样为氨苄西林（100%）、头孢唑林（97.9%）和呋喃妥因（97.9%）,耐药率比较低的为美罗培南（10.4%）、妥布霉素（16.7%）和环丙沙星（16.7%）,耐药率最低也为头孢哌酮/舒巴坦（6.3%）。结论 ICU分离耐亚胺培南鲍曼不动杆菌多重耐药性严重,出现了泛耐菌株;临床可根据药敏试验选用抗菌药物,一般条件下耐亚胺培南鲍曼不动杆菌建议选用头孢哌酮／舒巴坦。

Antimicrobial-resistant profile of imipenem-resistant Acinetobacter baumannii in intensive care unit

Objective To study the charateristics of drug resistance of imipenem-resistant Acinetobacter baumannii from hospitalized patients in ICU.Method Carbapenem-resistant Acinetobacter baumannii strains from intensive care units（ICU） during January 2006 and December 2007 were collected and isolated by coventional methods.The isolate identification and antibiotics MICs were determined by VITEK-AMS.Result 98 Acinetobacter baumannii isolates were collected,the main source of which was sputum,accouting for 94.9%,and 50（51%） strains were imipenem-resistant.There were 15 imipenem-resistant Acinetobacter baumannii strains, resistance rates of which to 16 antimicrobial agents were above 50%.The highest resistance rates were found to be against ampicillin（98.0%）,cefazolin（99.0%） and Nitrofurantoin（99.0%）,and the lowest resistance rates were against cefoperazone-sulbactam（10.2%）.Besides,there were 4 pan-resistant strains,and there were 4 strains with the resistance rates to 16 antimicrobial agents being above 50% in imipenem-sensitive Acinetobacter baumannii group.And resistance rates above 90% were ampicillin（100%）,cefazolin（97.9%） and Nitrofurantoin（97.9%）,while the lowest resistance rates were found for cefoperazone-sulbactam（6.3%）.Conclusionte The imipenem-resistant Acinetobacter baumannii from hospitalized patients in ICU have severe multidrug resistance and pan-drug resistance.According to susceptibility testing of antimicrobial agents,clinicians shall select appropriate drugs.Normally,we shall select cefoperazone-sulbactam to treat imipenem-resistant Acinetobacter baumannii.