中国执业药师
中國執業藥師
중국집업약사
CHINA LICENSED PHARMACIST
2014年
9期
9-11,15
,共4页
糖尿病%血流感染%病原菌%抗菌药%耐药
糖尿病%血流感染%病原菌%抗菌藥%耐藥
당뇨병%혈류감염%병원균%항균약%내약
Diabete%Bloodstream Infection%Pathogens%Antibacterials%Drug Resistance
目的：了解糖尿病合并血流感染患者病原菌分布及其对抗菌药的耐药情况。方法：回顾性分析我院内分泌科2008年1月-2014年6月100例糖尿病合并血流感染患者的血培养资料。结果：从糖尿病合并血流感染的患者中经血培养出大肠埃希菌57株（超广谱β-内酰胺酶（ESBL）阳性40株），肺炎克雷伯菌18株（ESBL7株），鲍曼不动杆菌13株，金黄色葡萄球菌12株（耐甲氧西林金黄色葡萄球菌（MRSA）6株）；药敏试验中对革兰阴性杆菌敏感多为半合成青霉素加酶抑制剂、第三代头孢菌素加酶抑制剂、第三代以上喹诺酮类、氨基苷类、碳青酶烯类抗菌药；对革兰阳性球菌敏感多为万古霉素、复方新诺明、呋喃妥因。结论：2型糖尿病合并血流感染病原菌多为革兰阴性杆菌，尤其是大肠埃希菌。对革兰阴性菌敏感的抗菌药依次为：碳青酶烯类抗生素＞半合成青霉素加酶抑制剂＞氨基苷类＞第三代头孢菌素加酶抑制剂＞第三代以上头孢菌素类。由于糖尿病患者多合并肾脏病变，需谨慎使用氨基苷类及喹诺酮类，碳青酶烯类抗菌药、半合成青霉素加酶抑制剂及第三代头孢菌素加酶抑制剂抗菌谱广而且作用较强，可作为治疗的首选。
目的：瞭解糖尿病閤併血流感染患者病原菌分佈及其對抗菌藥的耐藥情況。方法：迴顧性分析我院內分泌科2008年1月-2014年6月100例糖尿病閤併血流感染患者的血培養資料。結果：從糖尿病閤併血流感染的患者中經血培養齣大腸埃希菌57株（超廣譜β-內酰胺酶（ESBL）暘性40株），肺炎剋雷伯菌18株（ESBL7株），鮑曼不動桿菌13株，金黃色葡萄毬菌12株（耐甲氧西林金黃色葡萄毬菌（MRSA）6株）；藥敏試驗中對革蘭陰性桿菌敏感多為半閤成青黴素加酶抑製劑、第三代頭孢菌素加酶抑製劑、第三代以上喹諾酮類、氨基苷類、碳青酶烯類抗菌藥；對革蘭暘性毬菌敏感多為萬古黴素、複方新諾明、呋喃妥因。結論：2型糖尿病閤併血流感染病原菌多為革蘭陰性桿菌，尤其是大腸埃希菌。對革蘭陰性菌敏感的抗菌藥依次為：碳青酶烯類抗生素＞半閤成青黴素加酶抑製劑＞氨基苷類＞第三代頭孢菌素加酶抑製劑＞第三代以上頭孢菌素類。由于糖尿病患者多閤併腎髒病變，需謹慎使用氨基苷類及喹諾酮類，碳青酶烯類抗菌藥、半閤成青黴素加酶抑製劑及第三代頭孢菌素加酶抑製劑抗菌譜廣而且作用較彊，可作為治療的首選。
목적：료해당뇨병합병혈류감염환자병원균분포급기대항균약적내약정황。방법：회고성분석아원내분비과2008년1월-2014년6월100례당뇨병합병혈류감염환자적혈배양자료。결과：종당뇨병합병혈류감염적환자중경혈배양출대장애희균57주（초엄보β-내선알매（ESBL）양성40주），폐염극뢰백균18주（ESBL7주），포만불동간균13주，금황색포도구균12주（내갑양서림금황색포도구균（MRSA）6주）；약민시험중대혁란음성간균민감다위반합성청매소가매억제제、제삼대두포균소가매억제제、제삼대이상규낙동류、안기감류、탄청매희류항균약；대혁란양성구균민감다위만고매소、복방신낙명、부남타인。결론：2형당뇨병합병혈류감염병원균다위혁란음성간균，우기시대장애희균。대혁란음성균민감적항균약의차위：탄청매희류항생소＞반합성청매소가매억제제＞안기감류＞제삼대두포균소가매억제제＞제삼대이상두포균소류。유우당뇨병환자다합병신장병변，수근신사용안기감류급규낙동류，탄청매희류항균약、반합성청매소가매억제제급제삼대두포균소가매억제제항균보엄이차작용교강，가작위치료적수선。
Objective: To understand the pathogen distribution and drug resistance in diabetes combined with blood-stream infection. Methods: A retrospective analysis wag made of the blood cultivation data of 100 diabetes with blood-stream infection in our hospital from January of 2008 to June of 2014. Results:Through blood cultivation test,the following pathogens were found from the diabetes complicated with infection: 57 strains of Escheriehia coli. (40 ESBL positive strains),18 strains of Klebsiella pneumoniae (7 ESBL positive sreains),13 strains of Acinetobacter baumannii and 12 strains of Staphylococcus aureus (6 MRSA positive strains). The susceptibility test showed those antibiotics were mainly sensitive to Gram-negative bacilli,such as semisynthetic penicillin with enzyme inhibitor,the third generation of cephalosporin with enzyme inhibitor,over three generations of quinolones,aminoglycosides and carbapenem,and vancomycin,trimetho-prim-sulfamethoxazole and furadantin were responsive to Gram-positive cocci. Conclusion:The pathogens from type 2 dia-betes combined with bloodstream infection were most Gram-negative bacilli,especial Escheriehia coli. The antibacterials sensitive to Gram-negative bacteria include carbapenem,semisynthetic penicillin with enzyme inhibitor,aminoglycosides, the third generation of cephalosporin with enzyme inhibitor and over three generations of cephalosporins. Because of most diabetes combined with kidney diseases,caution is required in the use of aminoglycosides and quinolones. Carbapenem,semisynthetic penicillin with enzyme inhibitors and the third generation of cephalosporins with enzyme inhibitor have a broad and strong antibacterial spectrum and can be used as the first choice for treatment.
