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目的了解鲍曼不动杆菌院内感染株的产酶现状与耐药水平,为临床治疗与院感监控提供参考。方法按临床检验操作规程进行菌株分离鉴定,以Nitrocefin法检测β-内酰胺酶,用三维试验与K-B法进行酶型分析与药敏试验。结果临床分离175株鲍曼不动杆菌,82.28%来自呼吸道。产β-内酰胺酶124株,阳性率70.9%,其中,产超广谱β-内酰胺酶(ESBL)52株(41.9%),产头孢菌素酶(Am PC酶)70株(56.4%),产金属β-内酰胺酶(MBL)2株(1.6%)。本组菌株对常用抗菌药物广泛耐药,对头孢哌酮/舒巴坦(SCF)耐药率为37.7%,亚胺培南耐药率为1.1%(仅2株MBL耐药)。结论呼吸道是鲍曼不动杆菌院内感染主要途径;超广谱β-内酰胺酶与Am PC酶,是鲍曼不动杆菌主要耐药机制;减少耐碳青霉烯类肠杆菌感染是抗击耐药菌主要策略。
Objective To understand the enzyme-producing status and drug resistance of Acinetobacter baumannii isolates, and to provide reference for the clinical treatment and monitoring of nosocomial infection. Methods The strains were isolated and identified according to the rules of clinical laboratory tests. Nitrocefin method was used to detect β-lactamase. Enzymatic analysis and drug susceptibility test were performed with three-dimensional test and K-B method. Results The clinical isolates of 175 Acinetobacter baumannii, 82.28% from the respiratory tract. 124 strains of β-lactamase were produced with the positive rate of 70.9%. Among them, 52 strains (41.9%) of ESBLs and 70 strains (56.4%) produced cephalosporins (Am PC enzymes) ) And 2 strains of metallo-β-lactamase (MBL) (1.6%). The strains were widely resistant to commonly used antibacterials, resistant to cefoperazone / sulbactam (SCF) 37.7%, and imipenem 1.1% (only 2 MBL resistant). Conclusions The respiratory tract is the main route of nosocomial infection of Acinetobacter baumannii. Extended-spectrum β-lactamase and Am PC enzyme are the major mechanisms of drug resistance in Acinetobacter baumannii. Reducing the resistance to carbapenem-resistant enterobacteriae is a Pharmacopoeia main strategy.