NICU鲍曼不动杆菌的医院感染与耐药性分析

Healthcareassociated infection and drug resistance of Acinetobacter baumannii in neonatal intensive care units

摘要:

目的了解新生儿重症监护病房（NICU）鲍曼不动杆菌的临床特征及耐药性。方法对2012年10月—2014年10月某院4个NICU鲍曼不动杆菌医院感染临床分离情况及耐药性进行回顾性分析。结果4个NICU共收治新生儿11 640例，发生医院感染500例（4.3%），其中鲍曼不动杆菌医院感染51例（10.2%），52例次。鲍曼不动杆菌感染：极早产NICU 42例次，早产NICU 1例次，足月NICU 4例次，儿童外科NICU 5例次。4个季节鲍曼不动杆菌医院感染发病率比较，差异具有统计学意义（χ2=16.05，P<0.05），主要发生在春、夏两季。鲍曼不动杆菌对哌拉西林/舒巴坦、头孢吡肟、亚胺培南等β内酰胺类抗生素以及庆大霉素耐药率较高（＞90%），对阿米卡星耐药率最低，也高达51.9%。52株鲍曼不动杆菌中，46株为多耐药菌株，3株为广泛耐药菌株。 结论NICU 鲍曼不动杆菌医院感染最严重的是极早产NICU，对临床常用抗菌药物均呈现高耐药率。

Abstract:

ObjectiveTo investigate the clinical characteristics and antimicrobial resistance of Acinetobacter baumannii(A. baumannii) in neonatal intensive care units (NICUs). MethodsThe clinical isolation and antimicrobial resistance of A. baumannii causing healthcareassociated infection(HAI) in 4 NICUs of a hospital from October 2012 to October 2014 were analyzed statistically. Results A total of 11 640 neonates were admitted in 4 NICUs, 500(4.3%) developed HAI, 51(10.2%) developed 52 cases of A. baumannii infection. Distribution of A. baumannii infection was as follows: NICU of extremely premature infants, premature infants, fullterm infants，and surgical NICU were 42, 1, 4, and 5 cases respectively. Incidences of A. baumannii HAI in 4 seasons were compared, difference was statistically significant(χ2=16.05，P<0.05），infection mainly occurred in the spring and summer. A. baumannii had high resistance rates to βlactam antibiotics (such as piperacillin/sulbactam, cefepime, imipenem) and gentamycin（＞90%），resistance rate to amikacin was the lowest (51.9%). Among 52 strains of A. baumannii, 46 were multidrugresistant strains, and 3 were extensively drugresistant strains. ConclusionA. baumannii HAI is most serious in NICU of extremely premature infants, resistance rates to commonly used antimicrobial agents are high.