鲍曼不动杆菌临床分布、耐药性分析和肺部感染病例的预后研究

目的了解浙江大学医学院附属第一医院临床分离鲍曼不动杆菌的分布情况、耐药状况以及肺部感染病例的临床预后,为临床鲍曼不动杆菌感染的治疗提供参考。方法分析该院2013年1月至2013年6月培养到的非重复鲍曼不动杆菌420株的临床分布和耐药性,回顾性分析鲍曼不动杆菌肺炎并接受头孢哌酮/舒巴坦治疗患者的临床资料。结果 420株鲍曼不动杆菌来源以重症监护室（ICU）为主,占45.96%。其次为外科（神经外科、肝胆外科）,占36.19%。标本构成中以呼吸道标本最高（66.90%）,其次为血培养（8.81%）。共有79例（18.8%）患者≥2个部位分离到鲍曼不动杆菌,其中62例（78.5%）呼吸道是首发的分离部位、之后出现第二个部位培养阳性。体外药敏显示,鲍曼不动杆菌对阿米卡星、替加环素、左氧氟沙星、头孢哌酮/舒巴坦、氨苄西林/舒巴坦、亚胺培南和美罗培南的耐药率分别为5.2%、15.9%、35.6%、64.2%、71.1%、79.1%和88.9%。选取其中诊断为肺炎患者72例。72例患者粗死亡14例（19.4%）。患者病情好转组治疗初C反应蛋白平均水平为69.5 mg/L、死亡组为137.6 mg/L,经比较差异有统计学意义（P〈0.05）;患者病情好转组治疗初APACHE II为16.4、死亡组为19.7,经比较两组差异有统计学意义（P〈0.05）。结论入住重症监护室、外科手术后患者是鲍曼不动杆菌分离的主要人群,18.8%的患者在多个部位培养到鲍曼不动杆菌,鲍曼不动杆菌耐药率高,抗菌药物选择困难。治疗初期C反应蛋白和APACHE II水平对预后有参考价值。

Analysis on clicinal distribution and resistance of Acinetobacter baumannii and prognosis of pneumonia cases

Objective To analyze the clicinal distribution and resistance of Acinetobacter baumannii, and the prog- nosis of pneumonia cases caused by A. baumannii. Methods A total of 420 strains of A. baumannii isolated in the hospital during January 2013 to June 2013 were analyzed for the clicinal distribution and resistance. Clinical feature and outcome of A. baumannii pneumonia cases were also analyzed retrospectively. Results Among the 420 A. baumannii stranis, 193 were isolated from ICU （45. 96% ）, 152 were from the department of surgery （36.19%）. 66.9% of the strains were isolated from sputum and 8. 81% from blood cultures. In 79 cases （18.8%） , A. baumannii were isolated form more than 1 site. Among 62 cases, A. baumannii were isolated from sputum at first and then from other sites. The resistance rates of A. baumannii to amikacin, tigecycline, levofloxacin, cefoperazon/sulbactam, ampicillin/sulbactam, imipenem and meropenem were 5.2% , 15.9% , 35.6% ,64.2%, 71.1%, 79. 1% and 88.9% respectively. In the total 72 A. baumannii pneumonia cases, the crude death rate was 19.4%. The C-reaction protein （CRP） level of survival cases and death cases were 69.5 mg/L and 137.6 mg/L respectively （P 〈 0.05 ）. APACHE II score of survival cases and death cases were 16.4 and 19.7 re- spectively （P 〈0.05 ）. Conclusion A. baumannii is mostly isolated from patients who were admitted in ICU or underwent surgery. A. baumannii was isolated form more than 1 site in 18.8% of cases. Because of high resistance, it is difficult to treat the infection of A. baumannii. CRP and APACHE II scroe are the prediction factors of outcome m pneumoma cases.