CAJ | 학술논문

目的了解鲍曼不动杆菌在本院临床各病区的分布及耐药表型的流行特点,指导临床合理使用抗菌药物.方法对临床标本进行分离鉴定,采用K-B法对常规药物进行耐药检测,用NCCLS推荐的双纸片扩散法检测ESBLs酶、协同法检测金属酶,三维法检测AMPC酶.结果临床共分离出71株鲍曼不动杆菌,主要来源于痰标本(内三呼吸科占77.3%),占分离菌株的74.6%,其次是伤口分泌物,该菌对临床常规药物有不同程度耐药,对青霉素类、第1、2、3代头孢菌素类抗生素以及氨曲南均高度耐药,耐药率达71.0%～100%,其次是丁胺卡那、头孢吡肟、头孢哌酮/舒巴坦、环丙沙星,分别是12.6%,25.4%、40.8%、43.6%,对泰能、多粘菌素B、利福平耐药率最低.产酶菌株38株,不产酶菌株33株,产酶率为53.5%,产酶菌株中,单产ESBLs酶9株,占产酶株23.7%,产AMPC酶26株,占产酶株68.4%,产SSBL酶11株,占产酶株28.9%,产MBL酶3株,占产酶株7.89%.结论本院鲍曼不动杆菌呈现多重耐药,产酶菌株主要以产AMPC酶、ESBLs酶为主.
목적 료해포만불동간균재본원림상각병구적분포급내약표형적류행특점,지도림상합리사용항균약물.방법 대림상표본진행분리감정,채용K-B법대상규약물진행내약검측,용NCCLS추천적쌍지편확산법검측ESBLs매、협동법검측금속매,삼유법검측AMPC매.결과 림상공분리출71주포만불동간균,주요래원우담표본(내삼호흡과점77.3%),점분리균주적74.6%,기차시상구분비물,해균대림상상규약물유불동정도내약,대청매소류、제1、2、3대두포균소류항생소이급안곡남균고도내약,내약솔체71.0%～100%,기차시정알잡나、두포필우、두포고동/서파탄、배병사성,분별시12.6%,25.4%、40.8%、43.6%,대태능、다점균소B、리복평내약솔최저.산매균주38주,불산매균주33주,산매솔위53.5%,산매균주중,단산ESBLs매9주,점산매주23.7%,산AMPC매26주,점산매주68.4%,산SSBL매11주,점산매주28.9%,산MBL매3주,점산매주7.89%.결론 본원포만불동간균정현다중내약,산매균주주요이산AMPC매、ESBLs매위주.
Objective To investigate the clinical distribution in different wards and characteristics of resistant phenotype prevalence,so as to guide the clinic to use antibacterial agents rationally.Methods After isolation and identification,the clinical specimens were detected aboUt drug-resistance to common-used antibacterial agents by applying K-B method.Double-disc diffusion assay (NCCLs recommended)was employed to detect ESBLs,synergy method was adopted to measure metallic enzyme,and three-dimensional assay was applied to determining AMPC enzyme.Results Totally 71strains of Acinetobacter baumannii were isolated,which were mainly isolated from sputum samples (74.6% of isolater strains;77.3% were from respiratory department),followed by wound secretions.The bacterium was resistant to commonly-used antibacterial agents to varying degree.It was highly resistant to penicillins,the first-,second-and third-generation cephalosporin as well as aztreonam (resistance rate 71.O%-100%).Its resistance rate was 12.6%to amikacin,25.4%to cefepime,40.8% to cefoperazone/sulbactam,43.6% to ciprofloxacin;its resistance rate was very low to imipenem/cilastatin,polymycin B and rifapin.Totally 38 strains were enzyme-producting ones,33 strains were enzyme non-producting ones,and enzyme-producting rate was 53.5%.In enzyme-producting strains,9 strains produced single ESBL(23.7%),26 strains produced AMPC enzyme(68.4%),11strains produced SSBL enzyme (28.9%),and 3 strains produced MBL enzyme(7.89%).Conclusion Acinetobacter baumannii shows multi-resistance,and enzyme-producing strains mainly produce AMPC enzyme and ESgLs.