熊莺　孙午

[摘要] 目的 分析多重耐药鲍曼不动杆菌的临床分离和药敏情况，并与普通鲍曼不动杆菌的情况进行比较。 方法 回顾性分析49株多重耐药鲍曼不动杆菌和498株普通鲍曼不动杆菌的耐药情况，采用χ2检验分析两类细菌对常用抗菌药物的敏感性差异。 结果 药敏实验证实产鲍曼不动杆菌多重耐药株和普通株除对阿米卡星、多粘菌素B、氯霉素、氨曲南和头孢唑啉的敏感性差异无统计学意义外（P>0.05），对其他抗菌药物如亚南培南、环丙沙星等的敏感性都存在显著性差异（P<0.05），多重耐药鲍曼不动杆菌对很多抗菌药物的耐药率相比普通株都有很大程度的提高。 结论 多重耐药鲍曼不动杆菌存在耐药机制的多样性情况，在临床确诊鲍曼不动杆菌多重耐药株感染时应根据药敏结果合理用药，同时应珍惜使用对多重耐药鲍曼不动杆菌和普通鲍曼不动杆菌治疗同样有效的多粘菌素B及阿米卡星等抗菌药物。

[关键词] 鲍曼不动杆菌；多重耐药；多粘菌素B；阿米卡星

[中图分类号] R378.9 [文献标识码] B [文章编号] 1673-9701（2017）36-0128-03

[Abstract] Objective To analyze the clinical isolation and drug susceptibility of multidrug-resistant Acinetobacter baumannii and to compare with that of Acinetobacter baumannii. Methods The drug resistance of 49 multidrug-resistant Acinetobacter baumannii and 498 ordinary Acinetobacter baumannii was retrospectively analyzed. The differences of the sensitivity of the two kinds of bacteria to commonly used antimicrobial agents were analyzed by Chi-square test. Results The results of drug susceptibility test showed that there was no significant difference in the sensitivity to amikacin，polymyxin B， chloramphenicol， aztreonam and cefazolin between the multidrug-resistant strains of Acinetobacter baumannii and the common strains （P>0.05）. There was significant difference in the sensitivity to other antibacterial drugs such as imipenem and ciprofloxacin（P<0.05）. The drug resistance rate of multidrug-resistant Acinetobacter baumannii to many antibacterials have greatly improved， compared to that of ordinary strains. Conclusion There are a diversity of drug resistance mechanisms for multidrug-resistant Acinetobacter baumannii. When the infection of Acinetobacter baumannii multi-drug-resistant strains is clinically diagnosed， the drug should be used rationally according to the susceptibility results. At the same time，the antibiotics such as polymyxin B and amikacin， which have the same effect on multidrug-resistant strains and the common strains of Acinetobacter baumannii， shoud be used carefully.

[Key words] Acinetobacter baumannii； Multi-drug resistance； Polymyxin B； Amikacin

目前很多細菌产生耐药机制来源于抗生素大量在临床的应用，因而筛选出各种多重耐药的菌株，可以减少对人类的生命健康造成的威胁。鲍曼不动杆菌是医院感染的重要病原菌，近年来的感染在增多，并且其耐药性日益严重，引起临床和微生物学者的严重关注，本文通过对多重耐药鲍曼不动杆菌和普通鲍曼不动杆菌药敏情况的进行分析，希望进一步了解其耐药情况，找出两者耐药率存在差异的抗生素，从而谨慎对待，合理指导临床用药，避免耐药菌株的产生和扩散。

1 材料与方法

1.1 菌株来源

按卫生部《全国临床检验操作规程》第2版进行操作，从本院2010年1月～2013年12月临床送检标本获取547株鲍曼不动杆菌，其中498株为普通株，49株为多重耐药株。

1.2 细菌鉴定和药敏实验

细菌鉴定和药敏实验采用BD公司的phoenix100全自动微生物鉴定和药敏分析仪，“中介”结果纳入“耐药”处理以便于统计分析处理。