药物不良反应杂志
藥物不良反應雜誌
약물불량반응잡지
ADVERSE DRUG REACTIONS JOURNAL
2014年
3期
147-152
,共6页
康建邦%田志宏%李晓霞%张润梅%段金菊%张瑞琴
康建邦%田誌宏%李曉霞%張潤梅%段金菊%張瑞琴
강건방%전지굉%리효하%장윤매%단금국%장서금
微生物敏感性试验%抗菌药%病原菌
微生物敏感性試驗%抗菌藥%病原菌
미생물민감성시험%항균약%병원균
Microbial sensitivity tests%Anti-bacterial agents%Pathogens
目的:了解内、外科住院患者感染主要病原菌的种类及对抗菌药物的敏感性,为临床合理使用抗菌药物以及预防和控制耐药菌的产生提供科学依据。方法收集山西医科大学第二医院2012年内、外科住院患者感染病原菌和药敏试验报告单。送检标本包括尿、血液、病变部位分泌物、痰、粪便、咽拭子、脑脊液等。应用细菌耐药性监测网提供的WHONET 5.5软件及SPSS16.0软件对原始数据进行分析,比较内、外科患者感染病原菌的分布情况以及不同来源病原菌对不同抗菌药物的敏感率。结果共分离到来源于4092例内、外科住院患者的非重复病原菌4268株,其中内科患者2182例2257株,外科患者1910例2011株。来源于内科患者的病原菌前5位依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、凝固酶阴性葡萄球菌和阴沟肠杆菌;来源于外科患者的病原菌前5位依次为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌和阴沟肠杆菌。来源于内科患者的病原菌对抗菌药物的敏感率高于外科患者的有大肠埃希菌对头孢哌酮舒巴坦、头孢吡肟、头孢他啶、头孢曲松及头孢呋辛[62.7%(271/432)比58.0%(202/348),65.5%(283/432)比55.5%(193/348),63.8%(275/431)比53.3%(185/347),41.8%(180/431)比34.4%(120/349),34.0%(146/430)比26.6%(93/349)],阴沟肠杆菌对头孢吡肟[94.4%(151/160)比83.3%(140/168)],铜绿假单胞菌对阿米卡星[92.2%(190/206)比86.1%(230/267)],鲍曼不动杆菌对亚胺培南、美罗培南、头孢哌酮舒巴坦、环丙沙星及米诺环素[30.1%(31/103)比19.0%(41/216),29.7(30/101)比17.5%(38/217),19.4%(20/103)比10.8%(23/213),19.2%(19/99)比9.8%(20/204),23.2%(22/95)比11.1%(22/198)],敏感率低于外科患者的有金黄色葡萄球菌对复方新诺明、庆大霉素及克林霉素[54.8%(40/73)比78.9%(71/90),50.0%(37/74)比71.3%(62/87),28.8%(21/73)比46.6%(41/88)],肺炎克雷伯菌对左氧氟沙星[77.3%(269/348)比90.5%(239/264)],铜绿假单胞菌对妥布霉素[81.8%(148/181)比88.7%(235/265)]。上述差异均有统计学意义(均P﹤0.05)。结论内科与外科患者感染病原菌的种类不同,来源于内、外科患者的同一种病原菌对同一种抗菌药物的敏感性也不同,临床医生应结合药敏试验结果,合理使用抗菌药物。
目的:瞭解內、外科住院患者感染主要病原菌的種類及對抗菌藥物的敏感性,為臨床閤理使用抗菌藥物以及預防和控製耐藥菌的產生提供科學依據。方法收集山西醫科大學第二醫院2012年內、外科住院患者感染病原菌和藥敏試驗報告單。送檢標本包括尿、血液、病變部位分泌物、痰、糞便、嚥拭子、腦脊液等。應用細菌耐藥性鑑測網提供的WHONET 5.5軟件及SPSS16.0軟件對原始數據進行分析,比較內、外科患者感染病原菌的分佈情況以及不同來源病原菌對不同抗菌藥物的敏感率。結果共分離到來源于4092例內、外科住院患者的非重複病原菌4268株,其中內科患者2182例2257株,外科患者1910例2011株。來源于內科患者的病原菌前5位依次為大腸埃希菌、肺炎剋雷伯菌、銅綠假單胞菌、凝固酶陰性葡萄毬菌和陰溝腸桿菌;來源于外科患者的病原菌前5位依次為大腸埃希菌、銅綠假單胞菌、肺炎剋雷伯菌、鮑曼不動桿菌和陰溝腸桿菌。來源于內科患者的病原菌對抗菌藥物的敏感率高于外科患者的有大腸埃希菌對頭孢哌酮舒巴坦、頭孢吡肟、頭孢他啶、頭孢麯鬆及頭孢呋辛[62.7%(271/432)比58.0%(202/348),65.5%(283/432)比55.5%(193/348),63.8%(275/431)比53.3%(185/347),41.8%(180/431)比34.4%(120/349),34.0%(146/430)比26.6%(93/349)],陰溝腸桿菌對頭孢吡肟[94.4%(151/160)比83.3%(140/168)],銅綠假單胞菌對阿米卡星[92.2%(190/206)比86.1%(230/267)],鮑曼不動桿菌對亞胺培南、美囉培南、頭孢哌酮舒巴坦、環丙沙星及米諾環素[30.1%(31/103)比19.0%(41/216),29.7(30/101)比17.5%(38/217),19.4%(20/103)比10.8%(23/213),19.2%(19/99)比9.8%(20/204),23.2%(22/95)比11.1%(22/198)],敏感率低于外科患者的有金黃色葡萄毬菌對複方新諾明、慶大黴素及剋林黴素[54.8%(40/73)比78.9%(71/90),50.0%(37/74)比71.3%(62/87),28.8%(21/73)比46.6%(41/88)],肺炎剋雷伯菌對左氧氟沙星[77.3%(269/348)比90.5%(239/264)],銅綠假單胞菌對妥佈黴素[81.8%(148/181)比88.7%(235/265)]。上述差異均有統計學意義(均P﹤0.05)。結論內科與外科患者感染病原菌的種類不同,來源于內、外科患者的同一種病原菌對同一種抗菌藥物的敏感性也不同,臨床醫生應結閤藥敏試驗結果,閤理使用抗菌藥物。
목적:료해내、외과주원환자감염주요병원균적충류급대항균약물적민감성,위림상합리사용항균약물이급예방화공제내약균적산생제공과학의거。방법수집산서의과대학제이의원2012년내、외과주원환자감염병원균화약민시험보고단。송검표본포괄뇨、혈액、병변부위분비물、담、분편、인식자、뇌척액등。응용세균내약성감측망제공적WHONET 5.5연건급SPSS16.0연건대원시수거진행분석,비교내、외과환자감염병원균적분포정황이급불동래원병원균대불동항균약물적민감솔。결과공분리도래원우4092례내、외과주원환자적비중복병원균4268주,기중내과환자2182례2257주,외과환자1910례2011주。래원우내과환자적병원균전5위의차위대장애희균、폐염극뢰백균、동록가단포균、응고매음성포도구균화음구장간균;래원우외과환자적병원균전5위의차위대장애희균、동록가단포균、폐염극뢰백균、포만불동간균화음구장간균。래원우내과환자적병원균대항균약물적민감솔고우외과환자적유대장애희균대두포고동서파탄、두포필우、두포타정、두포곡송급두포부신[62.7%(271/432)비58.0%(202/348),65.5%(283/432)비55.5%(193/348),63.8%(275/431)비53.3%(185/347),41.8%(180/431)비34.4%(120/349),34.0%(146/430)비26.6%(93/349)],음구장간균대두포필우[94.4%(151/160)비83.3%(140/168)],동록가단포균대아미잡성[92.2%(190/206)비86.1%(230/267)],포만불동간균대아알배남、미라배남、두포고동서파탄、배병사성급미낙배소[30.1%(31/103)비19.0%(41/216),29.7(30/101)비17.5%(38/217),19.4%(20/103)비10.8%(23/213),19.2%(19/99)비9.8%(20/204),23.2%(22/95)비11.1%(22/198)],민감솔저우외과환자적유금황색포도구균대복방신낙명、경대매소급극림매소[54.8%(40/73)비78.9%(71/90),50.0%(37/74)비71.3%(62/87),28.8%(21/73)비46.6%(41/88)],폐염극뢰백균대좌양불사성[77.3%(269/348)비90.5%(239/264)],동록가단포균대타포매소[81.8%(148/181)비88.7%(235/265)]。상술차이균유통계학의의(균P﹤0.05)。결론내과여외과환자감염병원균적충류불동,래원우내、외과환자적동일충병원균대동일충항균약물적민감성야불동,림상의생응결합약민시험결과,합리사용항균약물。
Objective To understand the species and susceptibility of pathogens isolated from patients hospitalized in Departments of Internal Medicine and Surgery, and provide scientific basis for reasonable application of antibacterials and prevention and control of drug-resistant bacteria. Methods The pathogen isolation and drug sensitive test reports were collected from inpatients in Departments of Internal Medicine and Surgery in Second Hospital of Shanxi Medical University in 2012. The specimens included urine,blood,secretions,sputum,feces,throat swabs,cerebrospinal fluid,and so on. The original data were analyzed by WHONET 5. 5 and SPSS 16. 0 software and the distribution and susceptibility of pathogens isolated from patients hospitalized in Departments of Internal Medicine and Surgery were compared. Results A total of 4 268 strains of bacteria were isolated from 4 092 patients. Of them,2 257 strains were isolated from 2 182 patients in the Department of Internal Medicine and 2 011 were isolated from 1 910 patients in the Department of Surgery. The top 5 bacteria in Department of Internal Medicine were Escherichia coli,Klebsiellapneumonia,Pseudomonas aeruginosa,Coagulase-positive Staphylococcus aureus, and Aerobacter cloacae. The top 5 bacteria in Department of Surgery were Escherichia coli,Pseudomonas aeruginosa,Klebsiellapneumonia, Acinetobacter baumannii,and Aerobacter cloacae. The antimicrobial susceptibility of some pathogens isolated from patients in Department of Internal Medicine were higher than that in Department of Surgery,they were as follows:Escherichia coli vs. cefoperazone/sulbactam,cefepime, ceftazidime,ceftriaxone,amd cefuroxime nitrofurantoin[62. 7%(271/432)vs. 58. 0%(202/348),65. 5%(283/432)vs. 55. 5%(193/348),63. 8%(275/431)vs. 53. 3%(185/347),41. 8%(180/431)vs. 34. 4%(120/349),34. 0%(146/430)vs. 26. 6%(93/349)];Enterobacter cloacae vs. cefepime[94. 4%(151/160)vs. 83. 3%(140/168)];Pseudomonas aeruginosa vs. amikacin[92. 2%(190/206)vs. 86. 1%( 230/267 )]; Acinetobacter baumannii vs. imipenem, meropenem, cefoperazone/sulbactam, ciprofloxacin,and minocycline[30. 1%(31/103)vs. 19. 0%(41/216),29. 7(30/101)vs. 17. 5%(38/217),19. 4%(20/103)vs. 10. 8%(23/213),19. 2%(19/99)vs. 9. 8%(20/204),23. 2%(22/95)vs. 11. 1%(22/198)]. The antimicrobial susceptibility of some pathogens isolated from patients in Department of Internal Medicine were lower than that in Department of Surgery,they were as follows:Staphylococcus aureus vs. trimethoprim/sulfamethoxazole,gentamicin,clindamycin[54. 8%(40/73)vs. 78. 9%( 71/90 ),50. 0%( 37/74 ) vs. 71. 3%( 62/87 ),28. 8%( 21/73 ) vs. 46. 6%( 41/88 )];Klebsiella pneumoniae vs. levofloxacin [ 77. 3%( 269/348 ) vs. 90. 5%( 239/264 )], Pseudomonas aeruginosa vs. tobramycin[81. 8%(148/181)vs. 88. 7%(235/265)]. The differences above mentioned were statistically significant(all P﹤ 0. 05). Conclusions The species of bacteria isolated from patients in Department of Internal Medicine and Surgery are different and the susceptibility of the same kind of bacteria to the same kind of antibacterial agent is also different. Clinician should use antibacterials rationally according to the results of drug sensitivity tests.