2018 年第 10 期 第 13 卷

神经重症监护病房和重症监护病房患者鲍曼不动杆菌的耐药性及用药合理性比较

Drug resistance of Acinetobacter baumanii and rational antibacterial drug use in neurological intensive care unit and intensive care unit

作者：侯红玲张新江刘微丽林涛孙国先

英文作者：

单位：225001扬州大学附属医院神经内科(侯红玲、张新江)，重症医学科(刘微丽)，检验科(林涛)，药剂科(孙国先)

英文单位：

关键词：鲍曼不动杆菌；耐药性；不合理用药；神经重症监护病房

英文关键词：

• 摘要：

• 【摘要】目的    比较神经重症监护病房（NICU）和重症监护病房（ICU）鲍曼不动杆菌的耐药情况及抗菌药物的用药合理性。方法    选取扬州大学附属医院2017年1—12月鲍曼不动杆菌感染的住院患者134例，其中NICU 41例，ICU 93例。比较NICU和ICU患者基本信息、药敏试验结果、药物使用情况以及疾病转归等。结果    NICU分离的鲍曼不动杆菌对头孢噻肟、头孢他啶、亚胺培南、哌拉西林、哌拉西林他唑巴坦的耐药率较高，分别为87.8%（36/41）、85.4%（35/41）、82.9%（34/41）、90.2%（37/41）、87.8%（36/41）；ICU分离的鲍曼不动杆菌对头孢噻肟、头孢他啶、哌拉西林、哌拉西林他唑巴坦、磺胺甲唑/甲氧苄啶的耐药率较高，分别为78.5%（73/93）、76.3%（71/93）、90.3%（84/93）、84.9%（79/93）、81.7%（76/93）；NICU和ICU使用最多的抗菌药物是头孢哌酮舒巴坦和碳青霉烯类药物；NICU和ICU抗菌药物的使用存在多种不合理情况，其中用法用量及给药时机不当占比最高，分别占53.7%（22/41）、26.9%（25/93）。NICU和ICU不合理用药患者显效率均低于合理用药患者［34.8%(8/23)比72.2%（13/18）,37.8%（17/45）比81.3%（39/48）］。结论    临床分离的鲍曼不动杆菌耐药性较强，且NICU分离株的耐药性高于ICU；NICU和ICU均存在较多不合理用药情况，医师需要加强对抗菌药物知识的学习，提高用药水平。

• 【Abstract】Objective    To analyze drug resistance of Acinetobacter baumanii and rational antibacterial drug use in neurological intensive care unit(NICU) and intensive care unit(ICU). Methods    A total of 134 resident patients with Acinetobacter baumanii infection were enrolled at Affiliated Hospital of Yangzhou University from January to December 2017. Clinical data, drug sensitive test results, antibacterial drug use and prognosis of disease were analyzed between NICU patients(n＝41) and ICU patients(n＝93). Results    In NICU patients, resistance rates of Acinetobacter baumanii to cefotaxime, ceftazidime, imipenem, piperacillin and piperacillin-tazobactam were 87.8%（36/41）, 85.4%（35/41）, 82.9%（34/41）, 90.2%（37/41） and 87.8%（36/41）. In ICU patients, resistance rates of Acinetobacter baumanii to cefotaxime, ceftazidime, piperacillin, piperacillin-tazobactam and sulfamethoxazole/trimethoprim were 78.5%（73/93）, 76.3%（71/93）, 90.3%（84/93）, 84.9%（79/93） and 81.7%（76/93）. Cefoperazone sulbactam and carbopenems were the most commonly used antibacterials in NICU and ICU. Main causes of irrational antimicrobial use were inappropriate dosage［53.7%（22/41）］ and inappropriate timing of administration［26.9%（25/93）］. Effective rates in NICU and ICU patients with irrational antimicrobial use were lower than those in patients with rational drug use［34.8%(8/23) vs 72.2%（13/18）, 37.8%（17/45） vs 81.3%（39/48）］. Conclusions    Drug resistance of Acinetobacter baumanii isolated from NICU patients is higher than that isolated from ICU patients. Irrational antimicrobial use is common in NICU and ICU.