中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
4期
215-218
,共4页
温妙云%曾红科%黄伟平%方明
溫妙雲%曾紅科%黃偉平%方明
온묘운%증홍과%황위평%방명
血流感染%抗菌药物%细菌耐药%重症监护病房
血流感染%抗菌藥物%細菌耐藥%重癥鑑護病房
혈류감염%항균약물%세균내약%중증감호병방
Bloodstream infection%Antibacterial%Bacterial resistance%Intensive care unit
目的 监测本院重症监护病房(ICU)血流感染患者细菌分布及耐药状况,为临床合理选用抗菌药物提供依据.方法 收集本院ICU 2010年1月至2012年12月送检病原学标本,包括全血、导管血和骨髓标本分离的病原菌,采用纸片扩散法、微量稀释法或Etest法测定病原菌的药物敏感性,统计病原菌分布和抗菌药物耐药率.结果 3年共903例血流感染患者、分离得到病原菌1077株,其中革兰阳性(G+)菌639株、占59.33％,革兰阴性(G-)菌438株、占40.67％；排名前5位的病原菌依次为表皮葡萄球菌(20.06％,216株)、大肠埃希菌(13.93％,150株)、鲍曼不动杆菌(10.03％,108株)、肺炎克雷伯菌(7.80％,84株)、金黄色葡萄球菌(6.96％,75株),3年间细菌种类分布无差异.表皮葡萄球菌对多数测试药物的耐药率高于金黄色葡萄球菌,其中表皮葡萄球菌对喹努普汀/达福普汀(4.2％)和呋喃西林(15.3％)的耐药率相对较低,对青霉素(94.4％)、利奈唑烷(93.1％)、哌拉西林/他唑巴坦(90.3％)、头孢哌酮/舒巴坦(87.5％)和苯唑西林(83.3％)的耐药率均高于80％；金黄色葡萄球菌对青霉素(96.0％)、头孢哌酮/舒巴坦(84.0％)、利奈唑烷(76.0％)和苯唑西林(76.0％)的耐药率均高于70％,对其他常见抗菌药物的耐药率均低于70％.鲍曼不动杆菌对阿米卡星的耐药率为38.9％,对呋喃西林(91.7％)、头孢替坦(88.9％)、头孢他啶(88.9％)、氨苄西林(88.9％)、头孢曲松(86.1％)、头孢吡肟(86.1％)、氨曲南(80.6％)和头孢唑啉(80.6％)的耐药率均高于80％；大肠埃希菌除对阿米卡星(30.0％)、头孢替坦(24.0％)和亚胺培南(16.0％)的耐药率低于30％外,对氨苄西林/舒巴坦(94.0％)、左氧氟沙星(84.0％)、氨苄西林(84.0％)和头孢曲松(80.0％)的耐药率均高于80％.结论 ICU血流感染患者的病原菌中G+菌和G-菌的比例分别为59.33％和40.67％;而耐药率则G-菌较G+菌严重,主要致病菌的耐药率平均高达60％以上；在获得药敏结果前的经验性用药应兼顾G-菌及G+菌.
目的 鑑測本院重癥鑑護病房(ICU)血流感染患者細菌分佈及耐藥狀況,為臨床閤理選用抗菌藥物提供依據.方法 收集本院ICU 2010年1月至2012年12月送檢病原學標本,包括全血、導管血和骨髓標本分離的病原菌,採用紙片擴散法、微量稀釋法或Etest法測定病原菌的藥物敏感性,統計病原菌分佈和抗菌藥物耐藥率.結果 3年共903例血流感染患者、分離得到病原菌1077株,其中革蘭暘性(G+)菌639株、佔59.33％,革蘭陰性(G-)菌438株、佔40.67％；排名前5位的病原菌依次為錶皮葡萄毬菌(20.06％,216株)、大腸埃希菌(13.93％,150株)、鮑曼不動桿菌(10.03％,108株)、肺炎剋雷伯菌(7.80％,84株)、金黃色葡萄毬菌(6.96％,75株),3年間細菌種類分佈無差異.錶皮葡萄毬菌對多數測試藥物的耐藥率高于金黃色葡萄毬菌,其中錶皮葡萄毬菌對喹努普汀/達福普汀(4.2％)和呋喃西林(15.3％)的耐藥率相對較低,對青黴素(94.4％)、利奈唑烷(93.1％)、哌拉西林/他唑巴坦(90.3％)、頭孢哌酮/舒巴坦(87.5％)和苯唑西林(83.3％)的耐藥率均高于80％；金黃色葡萄毬菌對青黴素(96.0％)、頭孢哌酮/舒巴坦(84.0％)、利奈唑烷(76.0％)和苯唑西林(76.0％)的耐藥率均高于70％,對其他常見抗菌藥物的耐藥率均低于70％.鮑曼不動桿菌對阿米卡星的耐藥率為38.9％,對呋喃西林(91.7％)、頭孢替坦(88.9％)、頭孢他啶(88.9％)、氨芐西林(88.9％)、頭孢麯鬆(86.1％)、頭孢吡肟(86.1％)、氨麯南(80.6％)和頭孢唑啉(80.6％)的耐藥率均高于80％；大腸埃希菌除對阿米卡星(30.0％)、頭孢替坦(24.0％)和亞胺培南(16.0％)的耐藥率低于30％外,對氨芐西林/舒巴坦(94.0％)、左氧氟沙星(84.0％)、氨芐西林(84.0％)和頭孢麯鬆(80.0％)的耐藥率均高于80％.結論 ICU血流感染患者的病原菌中G+菌和G-菌的比例分彆為59.33％和40.67％;而耐藥率則G-菌較G+菌嚴重,主要緻病菌的耐藥率平均高達60％以上；在穫得藥敏結果前的經驗性用藥應兼顧G-菌及G+菌.
목적 감측본원중증감호병방(ICU)혈류감염환자세균분포급내약상황,위림상합리선용항균약물제공의거.방법 수집본원ICU 2010년1월지2012년12월송검병원학표본,포괄전혈、도관혈화골수표본분리적병원균,채용지편확산법、미량희석법혹Etest법측정병원균적약물민감성,통계병원균분포화항균약물내약솔.결과 3년공903례혈류감염환자、분리득도병원균1077주,기중혁란양성(G+)균639주、점59.33％,혁란음성(G-)균438주、점40.67％；배명전5위적병원균의차위표피포도구균(20.06％,216주)、대장애희균(13.93％,150주)、포만불동간균(10.03％,108주)、폐염극뢰백균(7.80％,84주)、금황색포도구균(6.96％,75주),3년간세균충류분포무차이.표피포도구균대다수측시약물적내약솔고우금황색포도구균,기중표피포도구균대규노보정/체복보정(4.2％)화부남서림(15.3％)적내약솔상대교저,대청매소(94.4％)、리내서완(93.1％)、고랍서림/타서파탄(90.3％)、두포고동/서파탄(87.5％)화분서서림(83.3％)적내약솔균고우80％；금황색포도구균대청매소(96.0％)、두포고동/서파탄(84.0％)、리내서완(76.0％)화분서서림(76.0％)적내약솔균고우70％,대기타상견항균약물적내약솔균저우70％.포만불동간균대아미잡성적내약솔위38.9％,대부남서림(91.7％)、두포체탄(88.9％)、두포타정(88.9％)、안변서림(88.9％)、두포곡송(86.1％)、두포필우(86.1％)、안곡남(80.6％)화두포서람(80.6％)적내약솔균고우80％；대장애희균제대아미잡성(30.0％)、두포체탄(24.0％)화아알배남(16.0％)적내약솔저우30％외,대안변서림/서파탄(94.0％)、좌양불사성(84.0％)、안변서림(84.0％)화두포곡송(80.0％)적내약솔균고우80％.결론 ICU혈류감염환자적병원균중G+균화G-균적비례분별위59.33％화40.67％;이내약솔칙G-균교G+균엄중,주요치병균적내약솔평균고체60％이상；재획득약민결과전적경험성용약응겸고G-균급G+균.
Objective To investigate the distribution and antibiotic resistance of bacteria causing bloodstream infections in intensive care unit (ICU) patients and to provide a basis for rational clinical use of antibiotics.Methods The data of positive specimens,including whole blood,catheter blood and bone marrow samples,were isolated from ICU patients from January 2010 to December 2012.Disc diffusion method,micro-dilution and Etest method were used to test drug sensitivity.Distribution and antibiotic resistance of bacteria were analyzed retrospectively.Results A total of 1077 strains were isolated from 903 patients with bloodstream infection during 3 years.Gram-positive (G+) bacteria and Gram-negative (G-) bacteria accounted for 59.33％ (639 isolates) and 40.67％ (438 isolates) respectively.The 5 most frequently isolated bacteria were Staphylococcus epidermidis (20.06％,216 isolates) followed in order by Escherichia coli (13.93％,150 isolates),Acinetobacter baumannii (10.03％,108 isolates),Klebsiella pneumonia (7.80％,84 isolates) and Staphylococcus aureus (6.96％,75 isolates).There was no significant difference in distribution of bacteria during 3 years.The resistance rate of Staphylococcus epidermidis was higher than that of Staphylococcus aureus to most of the tested drugs.The resistance rate of Staphylococcus epidermidis to quinoline/dalfopristin (4.2％) and nitrofurazone (15.3％) was relatively low,while resistance to penicillin (94.4％),linezolid (93.1％),piperacillin/tazobactam (90.3％),cefoperazone/sulbactam (87.5％) and oxacillin (83.3％) was over 80％.The resistance rate of Staphylococcus aureus to penicillin (96.0％),cefoperazone/sulbactam (84.0％),linezolid (76.0％) and oxacillin (76.0％) was over 70％,and resistance to the other common antibacterial drugs was below 70％.The resistance rate of Acinetobacter baumannii to amikacin (38.9％),nitrofurazone (91.7％),cefotetan (88.9％),ceftazidime (88.9％),ampicillin (88.9％),ceftriaxone (86.1％),the cefepime (86.1％),aztreonam (80.6％) and cefazolin (80.6％),and overall above 80％.The resistance rate of Escherichia coli to amikacin (30.0％),cefotetan (24.0％) and imipenem (16.0％) was below 30％,while resistance to ampicillin/sulbactam (94.0％),levofloxacin (84.0％),ampicillin (84.0％) and ceftriaxone (80.0％) was over 80％.Conclusions Among the bacteria causing bloodstream infection as isolated from ICU patients,G+ and G-bacteria accounted for 59.33％ and 40.67％,respectively.The resistance rate of G-was higher than that of G+,and resistance rate of majority of bacteria was higher than 60％ on average.Before obtaining the susceptibility test results,both G-and G+ should be taken into account on choosing antimicrobial drugs in the treatment of ICU patients.
