中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2012年
9期
30-35
,共6页
郑伟浩%伍国达%张丽珊%赵英萍
鄭偉浩%伍國達%張麗珊%趙英萍
정위호%오국체%장려산%조영평
医院感染%细菌%抗菌药物%抗药性
醫院感染%細菌%抗菌藥物%抗藥性
의원감염%세균%항균약물%항약성
Nosocomial infection%Bacteria%Antibacterials%Drug resistance
目的 探讨重症监护室院内感染细菌的分布及其耐药情况的变化趋势.方法 对2008年1月至2010年12月广东省江门市中心医院重症医学科院内感染的细菌及其耐药情况进行统计分析.结果 37.1%的院内感染为革兰阳性(G+)菌,62.9%为革兰阴性(G-)菌,其中大约81.3%为下呼吸道感染.在G+菌中,金黄色葡萄球菌占38.9%,表皮葡萄球菌、溶血葡萄球菌各占19.5%;葡萄球菌属对糖肽类、利奈唑胺和奎奴普丁/达福普汀保持100%敏感率,除了氯霉素、复方新诺明对金葡菌的耐药率较低外,其他药物的耐药率均很高,超过60%;凝固酶阴性葡萄球菌的耐药率更高.在G-菌中,阴性杆菌占20%,非发酵菌占50%,并且,鲍曼不动杆菌和嗜麦芽窄食单胞菌逐年增多;肺炎克雷伯杆菌对碳青霉烯类和阿米卡星耐药率最低,低于8%,且呈显著下降趋势;对头孢西丁耐药率约20%,对其他抗菌药的耐药率则显著上升;大肠埃希菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、碳青霉烯类和阿米卡星的耐药率低于20%,对头孢菌素类(除头孢西丁外)和喹诺酮类的耐药率整体超过80%.对铜绿假单胞菌耐药率最低的是多粘菌素B,其次是阿米卡星、哌拉西林/他唑巴坦;其他抗菌药耐药率高,但呈显著下降趋势.鲍曼不动杆菌对亚胺培南、米诺环素的耐药率不超过20%;对头孢哌酮/舒巴坦的耐药率最高,超过90%,其次为氨曲南,超过80%;而对其他抗菌药的耐药率低于铜绿假单胞菌.嗜麦芽窄食假单胞菌对米诺环素的耐药率最低(<10%),其次为复方新诺明、左旋氧氟沙星,耐药率低于36.4%,对其他药物的耐药率均很高.结论 ICU院内细菌感染以G-菌为主,鲍曼不动杆菌、嗜麦芽窄食单胞菌显著增多;整体细菌耐药率高,且绝大多数为多重耐药菌;铜绿假单胞菌耐药率呈下降趋势.
目的 探討重癥鑑護室院內感染細菌的分佈及其耐藥情況的變化趨勢.方法 對2008年1月至2010年12月廣東省江門市中心醫院重癥醫學科院內感染的細菌及其耐藥情況進行統計分析.結果 37.1%的院內感染為革蘭暘性(G+)菌,62.9%為革蘭陰性(G-)菌,其中大約81.3%為下呼吸道感染.在G+菌中,金黃色葡萄毬菌佔38.9%,錶皮葡萄毬菌、溶血葡萄毬菌各佔19.5%;葡萄毬菌屬對糖肽類、利奈唑胺和奎奴普丁/達福普汀保持100%敏感率,除瞭氯黴素、複方新諾明對金葡菌的耐藥率較低外,其他藥物的耐藥率均很高,超過60%;凝固酶陰性葡萄毬菌的耐藥率更高.在G-菌中,陰性桿菌佔20%,非髮酵菌佔50%,併且,鮑曼不動桿菌和嗜麥芽窄食單胞菌逐年增多;肺炎剋雷伯桿菌對碳青黴烯類和阿米卡星耐藥率最低,低于8%,且呈顯著下降趨勢;對頭孢西丁耐藥率約20%,對其他抗菌藥的耐藥率則顯著上升;大腸埃希菌對哌拉西林/他唑巴坦、頭孢哌酮/舒巴坦、碳青黴烯類和阿米卡星的耐藥率低于20%,對頭孢菌素類(除頭孢西丁外)和喹諾酮類的耐藥率整體超過80%.對銅綠假單胞菌耐藥率最低的是多粘菌素B,其次是阿米卡星、哌拉西林/他唑巴坦;其他抗菌藥耐藥率高,但呈顯著下降趨勢.鮑曼不動桿菌對亞胺培南、米諾環素的耐藥率不超過20%;對頭孢哌酮/舒巴坦的耐藥率最高,超過90%,其次為氨麯南,超過80%;而對其他抗菌藥的耐藥率低于銅綠假單胞菌.嗜麥芽窄食假單胞菌對米諾環素的耐藥率最低(<10%),其次為複方新諾明、左鏇氧氟沙星,耐藥率低于36.4%,對其他藥物的耐藥率均很高.結論 ICU院內細菌感染以G-菌為主,鮑曼不動桿菌、嗜麥芽窄食單胞菌顯著增多;整體細菌耐藥率高,且絕大多數為多重耐藥菌;銅綠假單胞菌耐藥率呈下降趨勢.
목적 탐토중증감호실원내감염세균적분포급기내약정황적변화추세.방법 대2008년1월지2010년12월광동성강문시중심의원중증의학과원내감염적세균급기내약정황진행통계분석.결과 37.1%적원내감염위혁란양성(G+)균,62.9%위혁란음성(G-)균,기중대약81.3%위하호흡도감염.재G+균중,금황색포도구균점38.9%,표피포도구균、용혈포도구균각점19.5%;포도구균속대당태류、리내서알화규노보정/체복보정보지100%민감솔,제료록매소、복방신낙명대금포균적내약솔교저외,기타약물적내약솔균흔고,초과60%;응고매음성포도구균적내약솔경고.재G-균중,음성간균점20%,비발효균점50%,병차,포만불동간균화기맥아착식단포균축년증다;폐염극뢰백간균대탄청매희류화아미잡성내약솔최저,저우8%,차정현저하강추세;대두포서정내약솔약20%,대기타항균약적내약솔칙현저상승;대장애희균대고랍서림/타서파탄、두포고동/서파탄、탄청매희류화아미잡성적내약솔저우20%,대두포균소류(제두포서정외)화규낙동류적내약솔정체초과80%.대동록가단포균내약솔최저적시다점균소B,기차시아미잡성、고랍서림/타서파탄;기타항균약내약솔고,단정현저하강추세.포만불동간균대아알배남、미낙배소적내약솔불초과20%;대두포고동/서파탄적내약솔최고,초과90%,기차위안곡남,초과80%;이대기타항균약적내약솔저우동록가단포균.기맥아착식가단포균대미낙배소적내약솔최저(<10%),기차위복방신낙명、좌선양불사성,내약솔저우36.4%,대기타약물적내약솔균흔고.결론 ICU원내세균감염이G-균위주,포만불동간균、기맥아착식단포균현저증다;정체세균내약솔고,차절대다수위다중내약균;동록가단포균내약솔정하강추세.
Objective To investigate the bacterial distribution and the changing trend of drug resistance in intensive care unit.Methods Bacterial distribution and antimicrobial resistant results of nosocomial infection in department of ICU,Jiangmen Central Hospital,between January 2008 and December 2010 were analyzed statistically.Results The 37.1% of nosocomial infections were Gram-positive(G +)bacteria,62.9% were Gram-negative(G-) bacteria,and about 81.3% of which were lower respiratory tract infections.Among G+ bacteria,staphylococcus aureus accounted for 38.9%,staphylococcus epidermidis and staphylococcus haemolyticus accounted for 19.5%,respectively; The sensitive rates of staphylococcus to glycopeptide,linezolid and quinupristin/dalfopristin maintained 100%,except chloramphenicol and cotrimoxazole,the resistance rates of S.aureus to other drugs were very high,more than 60% ; and the resistant rate of coagulase-negative staphylococci was more higher.Among G- bacteria,gram-negative bacilli accounted for 20%,and non-fermentative bacteria accounted for 50%,moreover,acinetobacter baumannii and stenotrophomonas maltophilia were increasing year by year.The resistance rates of Klebsiella pneumoniae to carbapenem and amikacin were the lowest,less than 8%,and which significant decreased; Resistance to cefoxitin was about 20%,and the other antimicrobial agents increased significantly.The resistance rates of Escherichia coli to piperacillin / tazobactam,cefoperazone /sulbactam,carbapenems and amikacin were below 20%,resistance rates to cephalosporins (except cefoxitin) and quinolone were more than 80%.The lowest resistance rate to Pseudomonas aeruginosa was Polymyxin B,followed by was amikacin,piperacillin / tazobactam,the resistance rates of other antibiotic were very high,but showed a significant decline trend.The resistance rates of acinetobacter baumannii to imipenem and minocycline were no more than 20% ; resistances to cefoperazone / sulbactam were thehighest,more than 90%,and followed by resistances to other antimicrobial agents were lower than Pseudomonas aeruginosa.The resistance rate of stenotrophomonas maltophilia to minocycline was the lowest (< 10%),followed by was cotrimoxazole and levofloxacin,which were lower than 36.4%,and the resistance rates of other drugs were more higher.Conclusions The main bacteria of nosocomial infections in ICU was G- bacteria.Acinetobacter baumannii and stenotrophomonas maltophilia increased significantly; Drug-resistant rate was high,and most were multiple drug-resistance; the resistance rate of pseudomonas aeruginosa showed a declining tendency.aztreonam,more than 80% ; While the