中华烧伤杂志
中華燒傷雜誌
중화소상잡지
16
2011年
2期
109-113
,共5页
烧伤%假单胞菌,铜绿%抗菌药%抗药性
燒傷%假單胞菌,銅綠%抗菌藥%抗藥性
소상%가단포균,동록%항균약%항약성
Burns%Pseudomonas aeruginosa%Anti-bacterial agents%Drug resistance
目的 了解烧伤病房铜绿假单胞菌耐药率和抗菌药物使用变化,为合理应用抗菌药物、缓解铜绿假单胞菌耐药程度提供依据.方法 采集2005年1月-2009年12月笔者单位5717例住院患者创面、导管、血液、大便、尿液、痰液标本,行细菌培养.计算各年标本送检率与细菌检出情况.分析5年间球菌与杆菌菌株数之比、细菌分布情况、铜绿假单胞菌耐药率、抗菌药物使用强度,对细菌耐药率和抗菌药物使用强度行相关分析.用WHONET 5.4软件处理细菌一般情况及铜绿假单胞菌耐药率数据,对其他数据行x2检验与Bivariate相关分析.结果 (1)5年间标本送检率差异无统计学意义(73.2%～76.1%,x2=5.583,P＞0.05).送检的各类标本共检出菌株1675株,细菌检出比例呈逐年增加趋势.菌株来源:创面1434株、导管39株、血液29株、大便3株、尿液13株、痰液157株.5年间球菌、杆菌菌株数之比差异有统计学意义(105:134～181:126,x2=14.806,P＜0.01).(2)各年主要检出细菌是金黄色葡萄球菌(占28%～42%)、铜绿假单胞菌(占10%～25%)及鲍氏不动杆菌(占10%～19%).(3)5年间,铜绿假单胞菌对12种抗菌药物耐药率差异均有统计学意义(x2值为47.911～308.095,P值均小于0.01),其中对阿米卡星、头孢他啶、亚胺培南/西司他丁的耐药率前4年呈下降趋势,第5年有所反弹.(4)头孢哌酮/舒巴坦与左氧氟沙星的使用强度呈降低趋势;万古霉素的使用强度始终处于前列,呈逐渐上升趋势.(5)铜绿假单胞菌对阿米卡星、亚胺培南/西司他丁、环丙沙星等7种抗菌药物的耐药率与多种抗菌药物使用强度呈显著正相关(r值为0.879～0.978,P＜0.05或P＜0.01).结论 笔者单位铜绿假单胞菌的耐药情况比较严重,与抗菌药物使用强度相关,需要通过严格掌握抗菌药物使用指征、策略性更换使用抗菌药物、联合用药、严格执行消毒隔离措施等综合手段来缓解.
目的 瞭解燒傷病房銅綠假單胞菌耐藥率和抗菌藥物使用變化,為閤理應用抗菌藥物、緩解銅綠假單胞菌耐藥程度提供依據.方法 採集2005年1月-2009年12月筆者單位5717例住院患者創麵、導管、血液、大便、尿液、痰液標本,行細菌培養.計算各年標本送檢率與細菌檢齣情況.分析5年間毬菌與桿菌菌株數之比、細菌分佈情況、銅綠假單胞菌耐藥率、抗菌藥物使用彊度,對細菌耐藥率和抗菌藥物使用彊度行相關分析.用WHONET 5.4軟件處理細菌一般情況及銅綠假單胞菌耐藥率數據,對其他數據行x2檢驗與Bivariate相關分析.結果 (1)5年間標本送檢率差異無統計學意義(73.2%～76.1%,x2=5.583,P＞0.05).送檢的各類標本共檢齣菌株1675株,細菌檢齣比例呈逐年增加趨勢.菌株來源:創麵1434株、導管39株、血液29株、大便3株、尿液13株、痰液157株.5年間毬菌、桿菌菌株數之比差異有統計學意義(105:134～181:126,x2=14.806,P＜0.01).(2)各年主要檢齣細菌是金黃色葡萄毬菌(佔28%～42%)、銅綠假單胞菌(佔10%～25%)及鮑氏不動桿菌(佔10%～19%).(3)5年間,銅綠假單胞菌對12種抗菌藥物耐藥率差異均有統計學意義(x2值為47.911～308.095,P值均小于0.01),其中對阿米卡星、頭孢他啶、亞胺培南/西司他丁的耐藥率前4年呈下降趨勢,第5年有所反彈.(4)頭孢哌酮/舒巴坦與左氧氟沙星的使用彊度呈降低趨勢;萬古黴素的使用彊度始終處于前列,呈逐漸上升趨勢.(5)銅綠假單胞菌對阿米卡星、亞胺培南/西司他丁、環丙沙星等7種抗菌藥物的耐藥率與多種抗菌藥物使用彊度呈顯著正相關(r值為0.879～0.978,P＜0.05或P＜0.01).結論 筆者單位銅綠假單胞菌的耐藥情況比較嚴重,與抗菌藥物使用彊度相關,需要通過嚴格掌握抗菌藥物使用指徵、策略性更換使用抗菌藥物、聯閤用藥、嚴格執行消毒隔離措施等綜閤手段來緩解.
목적 료해소상병방동록가단포균내약솔화항균약물사용변화,위합리응용항균약물、완해동록가단포균내약정도제공의거.방법 채집2005년1월-2009년12월필자단위5717례주원환자창면、도관、혈액、대편、뇨액、담액표본,행세균배양.계산각년표본송검솔여세균검출정황.분석5년간구균여간균균주수지비、세균분포정황、동록가단포균내약솔、항균약물사용강도,대세균내약솔화항균약물사용강도행상관분석.용WHONET 5.4연건처리세균일반정황급동록가단포균내약솔수거,대기타수거행x2검험여Bivariate상관분석.결과 (1)5년간표본송검솔차이무통계학의의(73.2%～76.1%,x2=5.583,P＞0.05).송검적각류표본공검출균주1675주,세균검출비례정축년증가추세.균주래원:창면1434주、도관39주、혈액29주、대편3주、뇨액13주、담액157주.5년간구균、간균균주수지비차이유통계학의의(105:134～181:126,x2=14.806,P＜0.01).(2)각년주요검출세균시금황색포도구균(점28%～42%)、동록가단포균(점10%～25%)급포씨불동간균(점10%～19%).(3)5년간,동록가단포균대12충항균약물내약솔차이균유통계학의의(x2치위47.911～308.095,P치균소우0.01),기중대아미잡성、두포타정、아알배남/서사타정적내약솔전4년정하강추세,제5년유소반탄.(4)두포고동/서파탄여좌양불사성적사용강도정강저추세;만고매소적사용강도시종처우전렬,정축점상승추세.(5)동록가단포균대아미잡성、아알배남/서사타정、배병사성등7충항균약물적내약솔여다충항균약물사용강도정현저정상관(r치위0.879～0.978,P＜0.05혹P＜0.01).결론 필자단위동록가단포균적내약정황비교엄중,여항균약물사용강도상관,수요통과엄격장악항균약물사용지정、책략성경환사용항균약물、연합용약、엄격집행소독격리조시등종합수단래완해.
Objective To study changes in the drug-resistance of Pseudomonas aeruginosa (PA)and the use of antibiotics in burn wards so as to optimize the use of antibiotic in the future. Methods Bacteria were isolated from specimens of blood, venous catheter, stool, sputum, urine, wound tissue from 5717 patients hospitalized in our burn wards within the duration of January 2005 to December 2009. The number of specimens examined and positive rates of bacteria were calculated. Changes in constituent ratio of cocci and bacilli, spectrum of bacteria, the drug-resistance rate of PA, and the usage of antibiotics were analyzed. The number of specimens examined, constituent ratio of cocci and bacilli, drug-resistance rate were processed with chi-square test. Bivariate correlation analysis was performed between the usage of antibiotics and the drug-resistance rate. Results (1) The number of specimens examined showed no statistical difference during the five years ( with rates from 73.2% to 76.1% , x 2 = 5. 583, P ＞ 0.05 ) , while constituent ratio of cocci and bacilli showed statistical difference (with ratios from 105:134 to 169: 126, x 2 =14. 806, P ＜0.01 ). The positive rates of bacteria were increasing in the five years. (2) One thousand six hundred and seventy-five strains were identified during the five years from different kinds of specimens, with 29 from blood, 39 from venous catheter, 3 from stool, 157 from sputum, 13 from urine, and 1434 from wound tissue. Among them, Staphylococcus aureus accounted for 28% to 42% , PA accounted for 10% to 25% , Acinetobacter baumannii accounted for 10% to 19% , and they were the predominant strains. (3)The difference among drug-resistance rates of PA to each kind of 12 antibiotics during the five years were statistically significant (with x2 values from 47. 911 to 308. 095, P values all below 0.01 ). The drug-resistance rates of PA to some antibiotics showed downward trend in the former four years, including amikacin,ceftazidime, and imipenem/cilastatin, but it rebounded in the fifth year. (4) There was descending trend in usage of cefoperazone/sulbactam and levofloxacin, but vancomycin was always used widely. (5) Drug-resistance rates of PA to 7 antibiotics, including amikacin, imipenem/cilastatin, and ciprofloxacin, etc. , were positively correlated with usage of various antibiotics (with r values from 0. 879 to 0. 978, P ＜ 0. 05 or P ＜0. 01). Conclusions In our burn wards, drug-resistant PA was prevalent. Disinfection and isolation measures,appropriate use of antibiotics,etc. can reduce PA infection.
