浙江医学
浙江醫學
절강의학
ZHEJIANG MEDICAL JOURNAL
2014年
12期
1063-1066
,共4页
赵岚%丁士标%谢利军%潘亚萍
趙嵐%丁士標%謝利軍%潘亞萍
조람%정사표%사리군%반아평
微生物培养%解读%抗菌药物%影响
微生物培養%解讀%抗菌藥物%影響
미생물배양%해독%항균약물%영향
Microbial cultures%Interpretation%Antimicrobial drugs%Affect
目的：探讨解读与遵从微生物培养及药敏结果对感染治疗效果的影响，就微生物实验室与临床合作共同提高病原学诊断水平提出对策。方法回顾性调查非ICU住院的264例有药敏报告的感染病例，调查该病例使用的抗菌药物与微生物药敏解读的符合度，以是否遵从药敏结果分组观察，比较患者基本情况、治疗72h的疗效、预后及细菌耐药机制的影响差异。结果29.55%的患者选择与药敏一致的抗菌药物；30.30%的患者根据药敏调整使用抗菌药物；40.15%的患者仍使用与药敏不一致的抗菌药物。遵从药敏组和非遵从组患者的血WBC计数有统计学差异[（8.5±5.1）×109/L vs （6.8±4.7）×109/L，P=0.011]，两组72h疗效有差异（P=0.016），而转归无差异（P=0.112）。比较感染产超广谱β-内酰胺酶（ESBL）的大肠埃希菌和肺炎克雷伯菌的患者47例，以及感染产AmpC酶的阴沟肠杆菌病例14例，发现是否针对耐药机制使用抗菌药物与患者转归均有统计学差异（P=0.026、0.023）。结论正确的微生物培养及药敏结果解读，尤其是耐药表型的判断对感染治疗效果有影响。对于重症或耐药菌感染的抗菌药物选择，需要临床和微生物人员的共同合作，提高病原学诊断水平。
目的：探討解讀與遵從微生物培養及藥敏結果對感染治療效果的影響，就微生物實驗室與臨床閤作共同提高病原學診斷水平提齣對策。方法迴顧性調查非ICU住院的264例有藥敏報告的感染病例，調查該病例使用的抗菌藥物與微生物藥敏解讀的符閤度，以是否遵從藥敏結果分組觀察，比較患者基本情況、治療72h的療效、預後及細菌耐藥機製的影響差異。結果29.55%的患者選擇與藥敏一緻的抗菌藥物；30.30%的患者根據藥敏調整使用抗菌藥物；40.15%的患者仍使用與藥敏不一緻的抗菌藥物。遵從藥敏組和非遵從組患者的血WBC計數有統計學差異[（8.5±5.1）×109/L vs （6.8±4.7）×109/L，P=0.011]，兩組72h療效有差異（P=0.016），而轉歸無差異（P=0.112）。比較感染產超廣譜β-內酰胺酶（ESBL）的大腸埃希菌和肺炎剋雷伯菌的患者47例，以及感染產AmpC酶的陰溝腸桿菌病例14例，髮現是否針對耐藥機製使用抗菌藥物與患者轉歸均有統計學差異（P=0.026、0.023）。結論正確的微生物培養及藥敏結果解讀，尤其是耐藥錶型的判斷對感染治療效果有影響。對于重癥或耐藥菌感染的抗菌藥物選擇，需要臨床和微生物人員的共同閤作，提高病原學診斷水平。
목적：탐토해독여준종미생물배양급약민결과대감염치료효과적영향，취미생물실험실여림상합작공동제고병원학진단수평제출대책。방법회고성조사비ICU주원적264례유약민보고적감염병례，조사해병례사용적항균약물여미생물약민해독적부합도，이시부준종약민결과분조관찰，비교환자기본정황、치료72h적료효、예후급세균내약궤제적영향차이。결과29.55%적환자선택여약민일치적항균약물；30.30%적환자근거약민조정사용항균약물；40.15%적환자잉사용여약민불일치적항균약물。준종약민조화비준종조환자적혈WBC계수유통계학차이[（8.5±5.1）×109/L vs （6.8±4.7）×109/L，P=0.011]，량조72h료효유차이（P=0.016），이전귀무차이（P=0.112）。비교감염산초엄보β-내선알매（ESBL）적대장애희균화폐염극뢰백균적환자47례，이급감염산AmpC매적음구장간균병례14례，발현시부침대내약궤제사용항균약물여환자전귀균유통계학차이（P=0.026、0.023）。결론정학적미생물배양급약민결과해독，우기시내약표형적판단대감염치료효과유영향。대우중증혹내약균감염적항균약물선택，수요림상화미생물인원적공동합작，제고병원학진단수평。
Objective To review the therapeutic outcomes of bacterial infection in relation to results of antibiotic suscepti-bility tests. Methods Clinical data of 264 non- ICU hospitalized patients with bacterial infection were retrospectively reviewed in relation to results of susceptibility reports. The correlation of clinical outcomes with the compliance of susceptibility test results was analyzed. Results The selection of antibiotics was according to susceptibility results in 29.55%cases;the use of antibiotics was based on modified susceptibility test in 30.30%cases;while in 40.15%cases the antibiotics use was not consistent with sus-ceptibility. There was significant difference in WBC counts between compliance and non- compliance groups [(6.8±4.7)×109/L vs (8.5±5.1)×109/L, P=0.011]. There was significant difference in 72 h efficacy between two groups(P=0.016);however, no dif-ference in outcome between two groups (P=0.112). For patients infected with extended- spectrum β- lactamase (ESBL)- pro-ducing Escherichia coli and Klebsiel a pneumoniae (n=47) and patients infected with AmpC β- lactamases- producing Enter-obacter cloacae (n=14) there were significant differences in therapeutic outcomes between compliance and non- compliance groups (P=0.026 and 0.023). Conclusion Correct interpretation and application of microbial susceptibility tests can improve therapeutic efficacy and outcomes for patients with bacterial infection.
