CAJ | 학술논문

目的：了解住院患者医院感染情况、菌群分布及耐药现状，为医院感染的控制和指导临床合理用药提供可靠的依据。方法对我院2013年1~8月住院患者送检标本分离所得1625株阳性菌株的菌群分布情况、耐药特点进行回顾性分析。结果在分离所得阳性菌株中，革兰阴性菌构成比明显高于革兰阳性菌，分离率依次为大肠埃希菌（16.4%），金黄色葡萄球菌（12.9%），铜绿假单胞菌（12.5%），肠杆菌属（9.9%），克雷伯菌属（6.8%）。根据标本来源分析，伤口分泌物分离率最高的是金黄色葡萄球菌（17%），痰液分离率最高的是铜绿假单胞菌（24.8%），中段尿和血液分离率最高的是大肠埃希菌（分别为45.8%和23.9%）。临床分布中， ICU病区以革兰阴性菌为主；金黄色葡萄球菌主要来自于骨伤科病区（占51.6%）；在各内科病区，革兰阴性菌和革兰阳性菌的构成比差别不大，在30%左右。耐药情况分析，三种主要G+球菌对万古霉素和利奈唑胺-的敏感率均＞95%；四种主要的G杆菌对美罗培南和亚胺培南的敏感性较好，敏感率为73%~100%；在非发酵菌中，铜绿假单胞菌对大部分抗菌药物仍保持一定的抗菌活性；而不动杆菌属已表现出多重耐药。结论病原菌在不同标本来源、不同临床病区的菌群分布具有各自的特点，与患者感染发生的部位、医源性操作行为有关；及时监测病原菌变化及耐药趋势，针对不同病原菌的耐药情况，合理选择抗生素，以减少多重耐药菌株的产生和发展。
목적：료해주원환자의원감염정황、균군분포급내약현상，위의원감염적공제화지도림상합리용약제공가고적의거。방법대아원2013년1~8월주원환자송검표본분리소득1625주양성균주적균군분포정황、내약특점진행회고성분석。결과재분리소득양성균주중，혁란음성균구성비명현고우혁란양성균，분리솔의차위대장애희균（16.4%），금황색포도구균（12.9%），동록가단포균（12.5%），장간균속（9.9%），극뢰백균속（6.8%）。근거표본래원분석，상구분비물분리솔최고적시금황색포도구균（17%），담액분리솔최고적시동록가단포균（24.8%），중단뇨화혈액분리솔최고적시대장애희균（분별위45.8%화23.9%）。림상분포중， ICU병구이혁란음성균위주；금황색포도구균주요래자우골상과병구（점51.6%）；재각내과병구，혁란음성균화혁란양성균적구성비차별불대，재30%좌우。내약정황분석，삼충주요G+구균대만고매소화리내서알-적민감솔균＞95%；사충주요적G간균대미라배남화아알배남적민감성교호，민감솔위73%~100%；재비발효균중，동록가단포균대대부분항균약물잉보지일정적항균활성；이불동간균속이표현출다중내약。결론병원균재불동표본래원、불동림상병구적균군분포구유각자적특점，여환자감염발생적부위、의원성조작행위유관；급시감측병원균변화급내약추세，침대불동병원균적내약정황，합리선택항생소，이감소다중내약균주적산생화발전。
Objective To understand the nosocomial infection status, flora distribution and drug resistance of inpatients, in order to provide the reliable basis for the clinical control of nosocomial infection and guidance of the clinical rational drug use. Methods The flora distribution and drug resistance characteristic of 1625 positive strains isolated from the specimens of inpatients in our hospital during January 2013 to Augest 2013 were retrospectively analyzed. Results In the isolated positive strains, the proportion of gram-negative bacteria was significantly higher than that of gram-postive bacteria, the isolation rate in turn were Escherichia coli(16.4%), Staphylococcus aureus(12.9%), pseudomonas aeruginosa(12.5%), Enterobacter spp(9.9%),Klebsiella pneumonia(6.8%).According to the specimen source, the S.aureus strains were mainly isolated from the wound specimens(17.0%); the isolated rate of sputum in pseudomonas aeruginosa was highest(24.8%); Escherichia coli had the highest isolated rate in the middle piece urine and blood(respectively 45.8% and 23.9%).In the clinical distrubion, the ICU dominated by gram-negative bacteria, Staphylococcus aureus came mainly from the orthopedic ward(51.6%); In the inernal medicine ward, the proportion of gram-negative bacteria and gram-postive bacteria were similar, which accounted for about 30%. The analysis of drug resistance showed that the sensitive rate of the three main gram-postive aureus to Vancomycin and Linezolid were more than 95.0%; the sensitive rate of the four major gram-negative bacilli to Meropenem and Imipenem were better and 73%-100%;In the non-fermentative bacteria, the pseudomonas aeruginosa to most antibiotics still maintained a certain antibacterial activity, but acinetobacter had multiple drug resistance. Conclusion Pathogenic bacteria has its own characteristics in different specimen source and different flora distribution from different clinical ward, and is associated with the parts of the infection and the iatrogenic operation behavior; Monitoring the change and drug resistance of pathogens in time, selecting the antibiotics reasonably for drug resistance of different pathogenic bacteria can reduce the emergence and development of multiple drug resistant strains.