CAJ | 학술논문

目的了解我院近年来常见细菌的分离率及耐药情况，为医院抗菌药物的遴选和临床合理应用提供依据。方法收集我院2008年1月～2012年6月临床送检标本，按照全国临床检验操作规程（第3版）培养、分离、鉴定，采用K-B纸片扩散法进行药敏试验。将分离出的病原菌及其药敏资料进行统计分析。结果4年多共分离到病原菌7180株，其中 G＋菌1799株，占25．1％；G-菌5381株，占74．9％。排名前5位的细菌依次为大肠埃希菌、肺炎克雷伯杆菌、铜绿假单胞菌、阴沟杆菌、鲍曼不动杆菌。鲍曼不动杆菌、金黄色葡萄球菌、铜绿假单胞菌的分离率逐年上升，特别是鲍曼不动杆菌上升的幅度比较大。美洛西林、丁胺卡那霉素、万古霉素、亚胺培南对目标细菌处于较低的耐药率。葡萄球菌属细菌对青霉素耐药率均在93％以上，对红霉素的耐药率在70％以上。未发现耐万古霉素的葡萄球菌。肺炎链球菌对青霉素的耐药率为43．1％，对红霉素、复方新诺明、克林霉素的耐药率在90％左右；对左氧氟沙星、氯霉素较敏感。肠杆菌科细菌对美洛西林、亚胺培南、丁胺卡那霉素较为敏感。铜绿假单胞菌耐药率最低的是多黏菌素B和美洛西林。鲍曼不动杆菌对米诺环素耐药率最低。结论我院常见细菌耐药情况与全国其他地区的水平相近，但美洛西林、氟喹诺酮类等对目标细菌的耐药率低于文献报道，临床应重视细菌学检查，根据细菌耐药情况合理使用抗菌药物。
목적료해아원근년래상견세균적분리솔급내약정황，위의원항균약물적린선화림상합리응용제공의거。방법수집아원2008년1월～2012년6월림상송검표본，안조전국림상검험조작규정（제3판）배양、분리、감정，채용K-B지편확산법진행약민시험。장분리출적병원균급기약민자료진행통계분석。결과4년다공분리도병원균7180주，기중 G＋균1799주，점25．1％；G-균5381주，점74．9％。배명전5위적세균의차위대장애희균、폐염극뢰백간균、동록가단포균、음구간균、포만불동간균。포만불동간균、금황색포도구균、동록가단포균적분리솔축년상승，특별시포만불동간균상승적폭도비교대。미락서림、정알잡나매소、만고매소、아알배남대목표세균처우교저적내약솔。포도구균속세균대청매소내약솔균재93％이상，대홍매소적내약솔재70％이상。미발현내만고매소적포도구균。폐염련구균대청매소적내약솔위43．1％，대홍매소、복방신낙명、극림매소적내약솔재90％좌우；대좌양불사성、록매소교민감。장간균과세균대미락서림、아알배남、정알잡나매소교위민감。동록가단포균내약솔최저적시다점균소B화미락서림。포만불동간균대미낙배소내약솔최저。결론아원상견세균내약정황여전국기타지구적수평상근，단미락서림、불규낙동류등대목표세균적내약솔저우문헌보도，림상응중시세균학검사，근거세균내약정황합리사용항균약물。
Objective To understand the situation of drug resistance rate of our hospital in recent years ,and to provide the basis for antimicrobial drugs selection and clinical rational application .Methods The clinical specimens of our hospital during January 2008 to June 2012 were separated and identified according to the clinical inspection procedures (the third edition) ,then the antimicrobi-al susceptibility were tested by Kirby-Bauer plate dilution method .The collected resistance data were analyzed .Results A total of 7 180 strains of pathogenic bacteria were separated in our hospital during nearly four and a half years ,among which the Gram pos-itives and negatives were 1 799 and 5 381 ,accounted for 25 .1% and 74 .9% ,respectively .The top five isolates in the bacteria were Escherichia coli ,Klebsiella pneumoniae ,Pseudomonas aeruginosa ,Enterobacter cloacae ,and Acinetobacter baumannii . The separation rate of A .baumanii ,Staphylococcus aureus ,and Pseudomonas aeruginosa were raising year by year ,especially A .baumanii .Mezlocillin ,amikacin ,vancomycin ,and imipenem were at a low resistance rate to target bacteria .The resistance rate of Staph bacteria to penicillin and erythromycin were above 93% and 70% ,respectively .No vancomycin resistant staphylo-coccus was found .The resistance rate of Streptococcus pneumoniae to penicillin were 43 .1% ,and to erythromycin .Compound sulfamethoxazole were about 90% ,but to levofloxacin ,chloromycetin were sensitive . Enterbacteriaceae bacteria to meziocillin , imipenem and amikacin were sensitive .The drug resistance rate of Pseudomonas aeruginosa to polymyxin B and mezlocillin were the lowest .and A .baumanii resistant to minocycline were the lowest .Conclusion The resistance to antimicrobial agents of com-mon bacteria in our hospital is a serious problem ,closing to the request of the nation′s level .But the resistance of mezlocillin ,flu-oroquinolones to target bacteria were less than other reports in the literature .The clinical doctors should attach importance to the bacteriologic studies ,and use the antimicrobial agents rationally .