CAJ | 학술논문

目的：分析呼吸内科下呼吸道感染住院患者革兰阴性杆菌分布及耐药性变化情况，为临床合理用药提供依据。方法分析2010年11月至2011年11月我院呼吸内科下呼吸道感染患者痰标本分离出的176株革兰阴性菌及耐药情况。结果我院呼吸科病房主要致病的革兰阴性菌依次为铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌、嗜麦芽窄食单胞菌、阴沟肠杆菌等；52株铜绿假单胞菌中对左氧氟沙星、哌拉西林/舒巴坦耐药率分别为21.1%和21.4%；对美罗培南、亚胺培南的耐药率分别为38.2%、48.9%；对阿米卡星、头孢哌酮/舒巴坦、头孢吡肟、头孢他啶、氨曲南等耐药率在26.0%～45.0%，对氨苄西林、氨苄西林/舒巴坦、其他头孢类测试药物的耐药率均在80%以上。21株鲍曼不动杆菌对所测试药物均显示较高耐药性，除阿米卡星及哌拉西林/他唑巴坦相对较低外，对美罗培南及亚胺培南耐药率达到42.4%和50.0%，对氨苄西林和一代头孢、二代头孢耐药率接近100%。嗜麦芽窄食单胞菌对左氧氟沙星、复方新诺明耐药率分别为27.3%、14.3%，对米诺环素仍呈敏感；大肠埃希菌和肺炎克雷伯菌ESBLs 的总检出率分别为72.7%和16.6%，大肠埃希菌产ESBLs株对庆大霉素、环丙沙星、左氧氟沙星及大多数B内酰胺酶类药物的耐药率在90.0%以上。肠杆菌科细菌中不同菌种对碳青霉烯类、哌拉西林他唑巴坦敏感率100%。结论革兰阴性菌是呼吸内科病房内感染的主要致病菌，对各种抗生素均呈不同程度耐药，为控制耐药菌株的产生和扩散，抗生素的合理使用和细菌耐药性的监测尤为重要。
목적：분석호흡내과하호흡도감염주원환자혁란음성간균분포급내약성변화정황，위림상합리용약제공의거。방법분석2010년11월지2011년11월아원호흡내과하호흡도감염환자담표본분리출적176주혁란음성균급내약정황。결과아원호흡과병방주요치병적혁란음성균의차위동록가단포균、폐염극뢰백균、포만불동간균、대장애희균、기맥아착식단포균、음구장간균등；52주동록가단포균중대좌양불사성、고랍서림/서파탄내약솔분별위21.1%화21.4%；대미라배남、아알배남적내약솔분별위38.2%、48.9%；대아미잡성、두포고동/서파탄、두포필우、두포타정、안곡남등내약솔재26.0%～45.0%，대안변서림、안변서림/서파탄、기타두포류측시약물적내약솔균재80%이상。21주포만불동간균대소측시약물균현시교고내약성，제아미잡성급고랍서림/타서파탄상대교저외，대미라배남급아알배남내약솔체도42.4%화50.0%，대안변서림화일대두포、이대두포내약솔접근100%。기맥아착식단포균대좌양불사성、복방신낙명내약솔분별위27.3%、14.3%，대미낙배소잉정민감；대장애희균화폐염극뢰백균ESBLs 적총검출솔분별위72.7%화16.6%，대장애희균산ESBLs주대경대매소、배병사성、좌양불사성급대다수B내선알매류약물적내약솔재90.0%이상。장간균과세균중불동균충대탄청매희류、고랍서림타서파탄민감솔100%。결론혁란음성균시호흡내과병방내감염적주요치병균，대각충항생소균정불동정도내약，위공제내약균주적산생화확산，항생소적합리사용화세균내약성적감측우위중요。
Objectives To provide the evidence for treatment to lower respiratory tract infections, a study on distribution and drug resistance analysis of Gram-negative bacteria was conducted in the department of respiratory. Methods Sputum samples were collected from inpatients with lower respiratory tract infections in department of respiratory of our hospital from November 2010 to November 2011. Gram-negative bacteria from these samples was isolated, then the distribution and drug resistance analysis of these bacteria was conducted. Results In respiratory ward of our hospital, the main pathogenic Gram-negative bacteria were Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, maltophilia Aeromonas, Enterobacter cloacae, etc. Of the 52 specimens were positive for Pseudomonas aeruginosa,levofloxacin, piperacillin/sulbactam resistance rates were 21.1%and 21.4%, respectively, Resistance rate to meropenem, imipenem were 38.2%, 48.9%;amikacin, cefoperazone/sulbactam, cefepime, ceftazidime, aztreonam resistance rate at 26.0%-45.0%, ampicillin, ampicillin/sulbactam, other cephalosporin resistance rates of drug testing in more than 80%.21 Acinetobacter baumannii tested for drugs showed high resistance, in addition to amikacin and piperacillin/tazobactam is relatively low, the meropenem and imipenem were 42.4%and 50.0%, ampicillin, and generation cephalosporins, second-generation cephalosporin resistance were close to 100%. Maltophilia Aeromonas levofloxacin, cotrimoxazole resistance rates were 27.3%, 14.3%, respectively, continued to show sensitivity to minocycline. Escherichia coli and Klebsiella pneumoniae ESBL s overall detection rate was 72.7%and 16.6%, respectively, of the E. coli strains producing ESBLs gentamicin, ciprofloxacin, levofloxacin, and most B amide enzymes of drug resistance rates above 90%. Different strains of Enterobacteriaceae to carbapenems, piperacillin tazobactam rate of 100%.Conclusion Gram-negative bacteria were major pathogens in the respiratory ward, They showed varying degrees of resistance to various antibiotics. To control the generation and spread of resistant strains, the rational use of antibiotics and bacterial resistance surveillance were important.