CAJ | 학술논문

目的：了解2012年我院细菌分离和耐药情况，为临床治疗提供依据。方法细菌鉴定和药敏实验采用VITEK微生物分析仪，耐药性分析采用WHONET5.4软件。结果2012年我院收集患者首次分离株2698株，最常见的菌种分别为大肠埃希菌(13.8%)、铜绿假单胞菌(12.4%)、白色假丝酵母菌(12.3%)、肺炎克雷伯菌(9.7%)、鲍曼不动杆菌(8.5%)、金黄色葡萄球菌(7.2%)、光滑假丝酵母菌(4.2%)、表皮葡萄球菌(3.8%)、粘质沙雷菌(3.0%)、阴沟肠杆菌(2.4%)，其中革兰阴性菌占57.6%，革兰阳性菌占22.9%，真菌占19.5%；耐甲氧西林金葡菌(methicillin resistant staphylococcus aureus，MRSA)检出率为65.6%，MRSA对β内酰胺类和其他抗菌药物的耐药率明显高于甲氧西林敏感的金葡菌(methicillin-sensitive staphylococcus aureus，MSSA)，未发现对万古霉素和利奈唑胺耐药的葡萄球菌；肠球菌对万古霉素的耐药率为3.8%，粪肠球菌对大多数抗菌药物的耐药率明显低于屎肠球菌；大肠埃希菌对亚胺培南和美罗培南的耐药率为0.6%、0.8%，低于肺炎克雷伯菌(8.3%、8.9%)；铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为41.3%、32.7%，对头孢吡肟的耐药率最低(20.4%)；鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为61.8%、61.4%，对阿米卡星的耐药率最低(30.3%)，但它对多种抗生素的耐药率较高，均在50%以上；2012年泛耐药铜绿假单胞菌检出率为2.1%；白色假丝酵母菌对伏立康唑敏感性最好，未发现耐药株。结论定期进行细菌耐药性监测有助于了解我院细菌耐药性变迁，为临床经验用药提供理论依据。
목적：료해2012년아원세균분리화내약정황，위림상치료제공의거。방법세균감정화약민실험채용VITEK미생물분석의，내약성분석채용WHONET5.4연건。결과2012년아원수집환자수차분리주2698주，최상견적균충분별위대장애희균(13.8%)、동록가단포균(12.4%)、백색가사효모균(12.3%)、폐염극뢰백균(9.7%)、포만불동간균(8.5%)、금황색포도구균(7.2%)、광활가사효모균(4.2%)、표피포도구균(3.8%)、점질사뢰균(3.0%)、음구장간균(2.4%)，기중혁란음성균점57.6%，혁란양성균점22.9%，진균점19.5%；내갑양서림금포균(methicillin resistant staphylococcus aureus，MRSA)검출솔위65.6%，MRSA대β내선알류화기타항균약물적내약솔명현고우갑양서림민감적금포균(methicillin-sensitive staphylococcus aureus，MSSA)，미발현대만고매소화리내서알내약적포도구균；장구균대만고매소적내약솔위3.8%，분장구균대대다수항균약물적내약솔명현저우시장구균；대장애희균대아알배남화미라배남적내약솔위0.6%、0.8%，저우폐염극뢰백균(8.3%、8.9%)；동록가단포균대아알배남화미라배남내약솔분별위41.3%、32.7%，대두포필우적내약솔최저(20.4%)；포만불동간균대아알배남화미라배남적내약솔분별위61.8%、61.4%，대아미잡성적내약솔최저(30.3%)，단타대다충항생소적내약솔교고，균재50%이상；2012년범내약동록가단포균검출솔위2.1%；백색가사효모균대복립강서민감성최호，미발현내약주。결론정기진행세균내약성감측유조우료해아원세균내약성변천，위림상경험용약제공이론의거。
Objective To provide the evidence for clinical treatment of bacterial infection by investigating the isolated bacteria from patients admitted to our hospital in 2012 and their drug resistance. Methods The bacteria were identified and their drug sensitivity was tested with the VITEK microbial analyzer. Their drug resistance was analyzed using the WHONET5.4. Results Among the 2 698 bacterial strains isolated in 2012 from patients in our hospital, the most common microorganism was E.coli (13.8%), followed by P. Aeruginosa (12.4%), C.albicans (12.3%), K.pneumoniae (9.7%), A.baumannii (8.5%), S.aurcus (7.2%), C.glabrata (4.2%), S.epidermidis (3.8%), S.marcescens (3.0%) and E.cloacae (2.4%). Of these bacteria, Gram-negative bacteria, Gram-positive bacteria, fungus, and methicillin resistant staphylococcus aureus (MRSA) accounted for 57.6%, 22.9%, 19.5% and 65.6%, respectively. The resistance of MRSA to β-lactams and other antimicrobial agents was significantly higher than that of methicillin-sensitive staphylococcus aureus (MSSA). No staphylococcus was sensitive to Vancomycin and linezolid. The resistance of enterococci to vancomycin was 3.8%. The resistance of E.faecalis to most antibiotics was significantly lower than that of E.faecium. The resistance of E.coli to imipenem and meropenem was significantly lower than that of K.pneumoniae (0.6%and 0.8%vs 8.3%and 8.9%). The resistance of P. aeruginosa to imipenem and meropenem was significantly higher than that of cefepime (41.3%and 32.7%vs 20.4%). The resistance of A.baumannii was significantly higher to imipenem, meropenem and different antibiotics than to amikacin (61.8%, 61.4%, > 50%vs 30.3%). The detection rate of pan-drug resistant P. aeruginosa was 2.1%in 2012. The sensitivity of Candida albicans was the highest to VOR and no resistant Candida albicans strain was isolated. Conclusion Regular bacterial drug resistance monitoring contribute to understanding its change and can thus provide the evidence for rational use of drugs in clinical practice.