CAJ | 학술논문

目的调查广州医学院第一附属医院临床常见分离菌对抗生素耐药性四年间的变迁.方法药敏试验采用纸片扩散法,依照美国临床实验室标准化委员会制定的各年度版本标准判定结果,数据分析采用WHONET5.4软件,对四年间的资料作回顾性调查分析.结果 2005-2008年共收集非重复分离菌7920株,革兰阴性菌为为5810株,革兰阳性菌2110株.MRSA的分离率从2005年的44.8%增加到2008年的67.7%,未出现对万古霉素、替考拉宁和利奈唑胺中介和耐药的葡萄球菌.肺炎链球菌对青霉素的不敏感率为28%.未出现对万古霉素耐药粪肠球菌和屎肠球菌.碳青酶烯类对肠杆菌科细菌耐药率低于5%,头孢吡肟4年来对肠杆菌科细菌敏感率在70%以上,头孢噻肟耐药率逐年维持在40%左右,含酶抑制剂的头孢哌酮/舒巴坦,哌拉西林/三唑巴坦的敏感性在80%以上,喹诺酮类环丙沙星、左氧氟沙星敏感率4年来低于50%;大肠埃希菌和肺炎克雷伯菌中ESBLs的总检出率分别为23.8%和32.1%,产ESBL株的耐药率明显高于非产ESBL株;2005-2007年产ESBL肺炎克雷伯菌对美罗培南敏感率为100%,2008年对美罗培南的耐药率为5.2%.4年来主要非发酵菌的分离率都有不同程度升高,总分离率排前三位的是铜绿假单胞菌(15%)、鲍曼不动杆菌(5.4%)、嗜麦芽寡养单胞菌(4.7%);铜绿假单胞菌对头孢噻肟、头孢他啶,头孢吡肟,庆大霉素、阿米卡星,环丙沙星、左氧氟沙星以及哌拉西林/三唑巴坦的耐药率4年来逐年呈下降趋势.结论肺炎克雷伯菌对碳青霉烯类耐药率上升,非发酵菌的分离率上升但耐药率下降,细菌总体耐药变化符合国内耐药监测变化的趋势但有本院的特点,监测结果对抗菌药物的选择和医院感染的控制有积极意义.
목적 조사엄주의학원제일부속의원림상상견분리균대항생소내약성사년간적변천.방법 약민시험채용지편확산법,의조미국림상실험실표준화위원회제정적각년도판본표준판정결과,수거분석채용WHONET5.4연건,대사년간적자료작회고성조사분석.결과 2005-2008년공수집비중복분리균7920주,혁란음성균위위5810주,혁란양성균2110주.MRSA적분리솔종2005년적44.8%증가도2008년적67.7%,미출현대만고매소、체고랍저화리내서알중개화내약적포도구균.폐염련구균대청매소적불민감솔위28%.미출현대만고매소내약분장구균화시장구균.탄청매희류대장간균과세균내약솔저우5%,두포필우4년래대장간균과세균민감솔재70%이상,두포새우내약솔축년유지재40%좌우,함매억제제적두포고동/서파탄,고랍서림/삼서파탄적민감성재80%이상,규낙동류배병사성、좌양불사성민감솔4년래저우50%;대장애희균화폐염극뢰백균중ESBLs적총검출솔분별위23.8%화32.1%,산ESBL주적내약솔명현고우비산ESBL주;2005-2007년산ESBL폐염극뢰백균대미라배남민감솔위100%,2008년대미라배남적내약솔위5.2%.4년래주요비발효균적분리솔도유불동정도승고,총분리솔배전삼위적시동록가단포균(15%)、포만불동간균(5.4%)、기맥아과양단포균(4.7%);동록가단포균대두포새우、두포타정,두포필우,경대매소、아미잡성,배병사성、좌양불사성이급고랍서림/삼서파탄적내약솔4년래축년정하강추세.결론 폐염극뢰백균대탄청매희류내약솔상승,비발효균적분리솔상승단내약솔하강,세균총체내약변화부합국내내약감측변화적추세단유본원적특점,감측결과대항균약물적선택화의원감염적공제유적겁의의.
Objective To investigate the distribution and prevalence of antimicrobial susceptibility in the First Affiliated Hospital of Guangzhou Medical College during 2005～2008.Methods Disc diffusion test was employed to study the antimicrobial resistance.WHONET 5.4 software was used for data analysis.Results A total of 7920 nonduplicate isolates were collected during 2005～2008.Gram-positive microorganisms accounted for 2110.Gram negative bacteria accounted for 5810.The prevalence of MRSA increased from 44.8%in 2005 to 67.7%in 2008.No vancomycin,teicoplanin and linezolid intermediate or resistant Staphylococcus aureus.Streptococcus pneumoniae nonesensitive to penicillin accounted for 28%. No vancomycin-resistant Enterococcus faecalis and Enterococcus feces were found.The rate of resistance to Green enzyme vinyl carbon in Enterobacteriaceae bacterial Was less than 5%,the rate of sensitive to cefepime by Enterobacteriaceae was more than 70%during 4 years,resistance to eefotaxime in Enterobacteriaceae maintain at 40%,rate of sensitivity to cefoperazone/sulbactam,piperacillin/tazobactam Was more than 80%,the sensity to ciprofloxacin,levofloxacin was below 50%during the 4 years.The rate of ESBLs produced by Escherichia coli and Klebsiella pneumoniae were 23.8%and 32.1%.ESBL producing strains were more resistant to the common antibiotics than ESBL non-producing strain.the rate of sensitive to meropenem by Klebsiella pneumonia during 2005～2007 was 100%,but it increased to 5.2%in 2008.during 4 years the most common non-fermentative bacterias isolated rate was Pseudomonas aeruginosa(15%),Acinetobacter baumannii(5.4%),Anopheles mahophilia single sobria(4.7%);the rate of sensitive to cefotaxime,ceftazidime,cefepime,gentamicin,amikacin,ciprofloxacin,levofloxacin by Pseudomonas aeruginosa declined by years during 2005～2008.Conclusion The rate of resistant to carbapenems by Klebsiella pneumoniae was increasing.the rate of separation by nonfermenters was increasing but the rate of resistance was declined.the trend of resistance pattern in line with the other districts in domestic but had its own characteristics.outcomes of the monitoring could provide useful information to the selection of antibiotics and hospital infection control.