倪建腾 马致洁 赵奎君

[摘要] 目的 分析鲍曼不动杆菌耐药发生与年龄、住院天数、住院次数、基础疾病、抗生素使用等方面的相关性，为临床防治鲍曼不动杆菌感染用药提供参考。 方法 收集2016年1～6月间在北京友谊医院住院并出现鲍曼不动杆菌感染的患者133例。记录其年龄、性别、住院天数、住院次数、基础病因、抗生素使用情况等，分析鲍曼不动杆菌耐药发生与患者年龄、基础病因、用药情况等的相关性。 结果 133例纳入患者平均年龄69.38岁，均对头孢唑啉耐药（100.00%）；其次为呋喃妥因128例（96.24%）与氨苄西林108例（81.20%）；其中37例（27.82%）纳入患者仅采用单一的抗生素进行治疗，治愈率为51.35%；94例（70.68%）纳入患者采用两种及两种以上的抗生素进行联合治疗，治愈率为26.32%。 结论 抗生素联用与否无统计学差异。

[关键词] 鲍曼不动杆菌；抗生素；耐药性

[中图分类号] R446.5 [文献标识码] B [文章编号] 1673-9701（2018）21-0145-04

[Abstract] Objective To analyze the correlation between the occurrence of drug resistance of Acinetobacter baumannii and the age， length of hospital stay， the time of hospitalization， basic diseases， and the use of antibiotics， in order to provide reference for clinical prevention and treatment of Acinetobacter baumannii infection. Methods A total of 133 patients with Acinetobacter baumannii infection in Beijing Friendship Hospital from January 2016 to June 2016 were collected. The age， sex， days of hospitalization， the time of hospitalization， basic causes， antibiotic use， etc. were recorded. The correlation between drug resistance of Acinetobacter baumannii and the patient's age， basic etiology， and medication status was analyzed. Results 133 patients included in the study with the average age of 69.38 years old were all resistant to cefazolin（100.00%）， followed by nitrofurantoin in 128 cases（96.24%） and ampicillin in 108 cases（81.20%）. Among them， 37 cases （27.82%） were treated with only a single antibiotic， and the cure rate was 51.35%. 94（70.68%） patients were treated with the combination of two or more antibiotics for the treatment， and the cure rate was 26.32%.Conclusion There is no statistical difference between combined antibiotics and non-combined antibiotics.

[Key words] Acinetobacter baumannii； Antibiotics； Drug resistance

鮑曼不动杆菌是一种非发酵阴性不动杆菌，其生命力强、传播途径广，该菌不仅在自然环境中广泛存在[1-3]，还可通过医务人员、手术器械、公共设施等在医疗机构内传播感染[4]。此外，鲍曼不动杆菌因其固有和获得性耐药机制的多样性、具有在干燥环境下长期存活的能力和形成细菌生物膜[5]，已成为临床中常见的多重耐药菌。流行病学调查显示[6]，截止至2010年，除头孢哌酮-舒巴坦外，鲍曼不动杆菌对其他头孢类抗菌药物的耐药率均高于40.00%，其中对头孢他啶、头孢噻肟的耐药率已达到66.70%与94.80%。目前防治鲍曼不动杆菌的措施主要为研发新型抗生素、抗生素联用以及控制抗生素剂量等手段[7]，但该菌的变异及耐药速度不断加快，临床中泛耐药鲍曼不动杆菌的检出率居高不下[8]，这已成为目前的研究重点与难点。……