Objective To analyse the clinical characteristics of Acinetobacter baumannii septicemia and bacterial drug resistance so as to guide clinical diagnosis and rational use of antimicrobial agents. Methods A retrospective study was carried out in 119 patients of Acinetobacter baumannii septicemia from March 2009 to October 2011 in West China Hospital of Sichuan University. The clinical feature, the underlying diseases and microbilogical characteristics were analyzed. Results In 119 cases, 98 were hospital acquired infection(HAI, 82.4%), the other were community acquired infection(CAI, 17.6%). CAI patients were complicated by pulmonary infection(42.9%), trauma(33.3%), severe pancreatitis(33.3%) , and mainly distributed in ICU and outpatient, endocrinology department and infectious diseases department. HAI patients were with pulmonary infection(57.4%) malignant tumor(23.5%), severe pancreatitis(20.4%) and more vulnerable to MODS. CAI patients, and mainly distributed in ICU, Hematology department, Cardiothoracic surgery department, Pediatric surgery department and orthopedic. All Acinetobacter baumannii strains were 100% resistant to ampicillin, 72.3%~92.4% to the third and fourth generation cephalosporins, 68. 1% to carbapenems, 63.9%~74.8% to aminoglycosides, and 68.9% to quinolones. In 63 strains assayed in-vitro susceptibility to cefoperazone-sulbactam, 66. 7% were sensitive(77.8% in CAI strains, 64.8% in HAI strains. And 35 strains(55.6%) was only sensitive to cefoperazone-sulbactam. Fourty-four patients(37.0%) were polymicrobial sepsis, 15.9%(7/44)in CAI patients, 84. l%(37/44) in HAI patients . Conclusion The HAI strains were more resistant than CAI strains. The septicemia patients mainly distributed in the ICU, hematology and surgical department. Polymicrobial sepsis and MODS were common. The antibiotics resistance of hospital acquired Acinetobacter baumannii septicemia was a challenge.%目的 探讨鲍曼不动杆菌败血症临床特点和致病菌药敏情况,为临床诊断和合理用药提供依据.方法 收集四川大学华西医院2009年3月-2011年10月31个月中鲍曼不动杆菌败血症所有病例资料,回顾性分析临床特点、基础疾病及微生物学特征.结果 119例患者中,医院感染98例(82.4％),见于ICU、血液科、心胸外科、小儿外科及骨科,常见原发病灶或基础疾病依次是肺部感染(57.4％)、恶性肿瘤(23.5％),重症胰腺炎(20.4％),医院感染者更易发生多器官功能衰竭.社区感染21例(17.6％),来源于ICU及门诊,常见原发病灶或基础疾病依次是肺部感染(42.9％),外伤(33.3％),重症胰腺炎(33.3％),恶性肿瘤(23.8％).所有菌株对氨苄西林100％耐药,对第三、第四代头孢菌素耐药率72.3％～92.4％、对碳青霉烯类者68.1％、氨基糖苷类63.9％～74.8％、氟喹诺酮类68.9％,在所有菌株中63株对头孢哌酮/舒巴坦的敏感率为66.7％,其中社区感染株7/9敏感,医院感染株64.8％(35/54)敏感,两种来源菌株中35株(55.6％)仅对头孢哌酮/舒巴坦敏感.复数菌败血症共44例(37.0％),社区感染7例(15.9％),医院感染37例(84.1％).结论 鲍曼不动杆菌败血症主要见于ICU、血液科及外科性质科室,医院感染鲍曼不动杆菌较社区感染菌株更加耐药,且为多重耐药,易合并复数菌败血症及多器官功能衰竭.
展开▼
