中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2013年
8期
748-751
,共4页
鲍氏不动杆菌%抗药性,多种,细菌%不动杆菌感染%药物疗法,联合
鮑氏不動桿菌%抗藥性,多種,細菌%不動桿菌感染%藥物療法,聯閤
포씨불동간균%항약성,다충,세균%불동간균감염%약물요법,연합
Acinetobacter baumannii%Drug resistance,multiple,bacterial%Acinetobacter infections%Drug therapy,combination
目的 分析微生物室菌库中多重耐药鲍曼不动杆菌(MDRAb)的耐药性及其相关病例.方法 回顾性分析.选取2008年2至8月北京友谊医院住院患者中分离的38株多重耐药饱曼不动杆菌及其药敏结果；PCR法检测随机筛选出的非重复38株MDRAb耐药基因,核查其中37株MDRAb所属患者病历资料,另1株因病历资料被借出无法统计.结果 ICU的MDRAb耐药率最高,其中对常用抗不动杆菌药物中的头孢类如头孢他啶、头孢曲松,氨基糖苷类如庆大霉素、环丙沙星以及碳青霉烯类美罗培南、亚胺培南100％ (37/37)耐药；舒巴坦联合β内酰胺酶抑制剂比β内酰胺酶抑制剂单用更具敏感性；PCR证实全部MDRAb基因组中均携带OXA-23及OXA-51；病历提示MDRAb感染患者以老年患者居多,其中70～79岁所占比重最大,达46％,老年患者基础疾病多,免疫力低下,接受创伤性操作以及多种抗生素治疗,预后不良.结论 ICU的MDRAb耐药率高,治疗具体病患的同时应防范暴发流行；本地区MDRAb耐药机制与OXA-23密切相关；对于临床MDRAb感染患者联合用药治疗很有必要,其中舒巴坦起重要作用；老年且基础疾病多的患者尤其注意提高其免疫力、减少侵入性操作以及合理使用抗生素.
目的 分析微生物室菌庫中多重耐藥鮑曼不動桿菌(MDRAb)的耐藥性及其相關病例.方法 迴顧性分析.選取2008年2至8月北京友誼醫院住院患者中分離的38株多重耐藥飽曼不動桿菌及其藥敏結果；PCR法檢測隨機篩選齣的非重複38株MDRAb耐藥基因,覈查其中37株MDRAb所屬患者病歷資料,另1株因病歷資料被藉齣無法統計.結果 ICU的MDRAb耐藥率最高,其中對常用抗不動桿菌藥物中的頭孢類如頭孢他啶、頭孢麯鬆,氨基糖苷類如慶大黴素、環丙沙星以及碳青黴烯類美囉培南、亞胺培南100％ (37/37)耐藥；舒巴坦聯閤β內酰胺酶抑製劑比β內酰胺酶抑製劑單用更具敏感性；PCR證實全部MDRAb基因組中均攜帶OXA-23及OXA-51；病歷提示MDRAb感染患者以老年患者居多,其中70～79歲所佔比重最大,達46％,老年患者基礎疾病多,免疫力低下,接受創傷性操作以及多種抗生素治療,預後不良.結論 ICU的MDRAb耐藥率高,治療具體病患的同時應防範暴髮流行；本地區MDRAb耐藥機製與OXA-23密切相關；對于臨床MDRAb感染患者聯閤用藥治療很有必要,其中舒巴坦起重要作用；老年且基礎疾病多的患者尤其註意提高其免疫力、減少侵入性操作以及閤理使用抗生素.
목적 분석미생물실균고중다중내약포만불동간균(MDRAb)적내약성급기상관병례.방법 회고성분석.선취2008년2지8월북경우의의원주원환자중분리적38주다중내약포만불동간균급기약민결과；PCR법검측수궤사선출적비중복38주MDRAb내약기인,핵사기중37주MDRAb소속환자병력자료,령1주인병력자료피차출무법통계.결과 ICU적MDRAb내약솔최고,기중대상용항불동간균약물중적두포류여두포타정、두포곡송,안기당감류여경대매소、배병사성이급탄청매희류미라배남、아알배남100％ (37/37)내약；서파탄연합β내선알매억제제비β내선알매억제제단용경구민감성；PCR증실전부MDRAb기인조중균휴대OXA-23급OXA-51；병력제시MDRAb감염환자이노년환자거다,기중70～79세소점비중최대,체46％,노년환자기출질병다,면역력저하,접수창상성조작이급다충항생소치료,예후불량.결론 ICU적MDRAb내약솔고,치료구체병환적동시응방범폭발류행；본지구MDRAb내약궤제여OXA-23밀절상관；대우림상MDRAb감염환자연합용약치료흔유필요,기중서파탄기중요작용；노년차기출질병다적환자우기주의제고기면역력、감소침입성조작이급합리사용항생소.
Objective To investigate the resistance and infection case for the Multidrug-Resistant Acinetobacter baumanii (MDRAb) strains.Methods Retrospective study.Thirty-eight MDRAb strains were collected in Beijing Friendship Hospital from February to August 2008.VITEK2-compact system was used to detect the MDRAb.PCR was carried out to detect their resistance related genes and look up the medical records those who were infected by MDRAb.Results The resistance rate of the MDRAb is the highest in ICU.PCR confirmed that OXA-23 and OXA-51 were 100％ related with the MDRAb.Combination drug therapy such as sulbactam combined with β-lactam antibiotics was more effective than β-lactam antibiotics only to treat the infection with MDRAb.Cases analysis showed that a number of patients infected by MDRAb were the aged with basic diseases,low immunity,received a variety of antibiotic therapy even traumatic operation,and they had a poor prognosis finally.Conclusions The resistance rate of the MDRAb is the highest in ICU,OXA-23 is closely related to multidrug-resistance.Combination drug therapy is necessary and sulbactam can play a great role in curing the inpatients infected with MDRAb.
