CAJ | 학술논문

目的：监测2000～2013年北京协和医院血培养分离病原菌的分布和药物敏感性。方法收集2000～2013年北京协和医院门急诊和住院患者血培养分离病原菌。采用纸片扩散法测定菌株对抗菌药物的敏感性。采用WHONET5．6软件进行耐药性分析。结果除外棒杆菌属、痤疮丙酸杆菌、微球菌属和芽孢杆菌属，2000～2013年全院血培养共分离非重复病原菌7199株。革兰阴性需氧和兼性厌氧菌分离率为40．6％～54．2％，凝固酶阴性葡萄球菌的分离率为18．7％～35．1％，其他革兰阳性需氧菌和兼性厌氧菌（主要为金黄色葡萄球菌、肠球菌和链球菌）分离率为19．7％～25．8％；酵母菌分离率为0．5％～5．7％。2011～2013年血培养病原菌药敏试验结果显示，大肠埃希菌和肺炎克雷伯菌对美罗培南、亚胺培南和厄他培南最为敏感。除氨曲南外，铜绿假单胞菌对其他药物的敏感率均大于70．0％。除米诺环素外，鲍曼不动杆菌对其他药物的敏感率均小于25．0％。在凝固酶阴性葡萄球菌和金黄色葡萄球菌中，甲氧西林耐药菌株所占比例分别为80．7％和42．3％，对利奈唑胺、万古霉素、替考拉宁最为敏感。结论北京协和医院血培养分离菌株中革兰阴性菌占优势，且近年有升高趋势，凝固酶阴性葡萄球菌的分离率近5年逐年降低，念珠菌分离率呈上升趋势。碳青霉烯类药物对肠杆菌科细菌的抗菌活性最强。利奈唑胺、万古霉素和替考拉宁对革兰阳性球菌抗菌活性最强。
목적：감측2000～2013년북경협화의원혈배양분리병원균적분포화약물민감성。방법수집2000～2013년북경협화의원문급진화주원환자혈배양분리병원균。채용지편확산법측정균주대항균약물적민감성。채용WHONET5．6연건진행내약성분석。결과제외봉간균속、좌창병산간균、미구균속화아포간균속，2000～2013년전원혈배양공분리비중복병원균7199주。혁란음성수양화겸성염양균분리솔위40．6％～54．2％，응고매음성포도구균적분리솔위18．7％～35．1％，기타혁란양성수양균화겸성염양균（주요위금황색포도구균、장구균화련구균）분리솔위19．7％～25．8％；효모균분리솔위0．5％～5．7％。2011～2013년혈배양병원균약민시험결과현시，대장애희균화폐염극뢰백균대미라배남、아알배남화액타배남최위민감。제안곡남외，동록가단포균대기타약물적민감솔균대우70．0％。제미낙배소외，포만불동간균대기타약물적민감솔균소우25．0％。재응고매음성포도구균화금황색포도구균중，갑양서림내약균주소점비례분별위80．7％화42．3％，대리내서알、만고매소、체고랍저최위민감。결론북경협화의원혈배양분리균주중혁란음성균점우세，차근년유승고추세，응고매음성포도구균적분리솔근5년축년강저，념주균분리솔정상승추세。탄청매희류약물대장간균과세균적항균활성최강。리내서알、만고매소화체고랍저대혁란양성구균항균활성최강。
Objective To investigate distribution and antimicrobial resistance among blood culture pathogens in Peking Union Medical College Hospital from 2000 to 2013 .Methods Pathogens from outpatients′and inpatients′blood cultures in this hospital were collected continuously from 2000 to 2013 .Disk diffusion method was used to de-termine the in vitro susceptibility of pathogens to antimicrobial agents .WHONET5 .6 software was used to analyze the data .Results A total of 7 199 non-repetitive blood culture pathogens were isolated from 2000 to 2013 ,excluding Corynebacteirum spp ,Propionibacterium acnes ,Micrococcus spp and Bacillus spp .Gram-negative aerobic and Faculta-tively-anaerobic pathogens accounted for 40 .6% - 54 .2% .Coagulase-negative Staphylococcus accounted for 18 .7% -35 .1% .The proportion of other gram-positive cocci ,including mainly Staphylococcus aureus ,Enterococcus spp and Streptococcus spp ,was stable ,with isolation rate of 19 .7% -25 .8% .Fungi with isolation rate of 0 .5% -5 .7% .The resistance data from 2011 to 2013 revealed that the most active antimicrobial agents against Escherichia coli and Klebsiella pneumonia were meropenem ,imipenem and ertapenem .Against Pseudomonas aeruginosa ,the sus-ceptibility rates to drugs were more than 70 .0% except aztreonam .Against Acinetobacter baumannii ,the susceptibili-ty rates to drugs were less than 25 .0% except minocycline .Against Coagulase-negative Staphylococcus and staphylo-coccus aureus ,the methicillin resistance rate was 80 .7% and 42 .3% respectively .Drugs with high activity included linezolid ,vancomycin and teicoplanin .Conclusion Gram-negative bacteria could account for major part of the blood culture pathogens ,with increasing trend in recent years in this hospital .The isolation rate of coagulase-negative staphylococcu decreased in recent five years and Candida isolation rate increased .Carbapenems might be the most ac-tive drugs against Enterobacteriaceae .Linezolid ,vancomycin and teicoplanin could be the most potent antimicrobial a-gents against Gram-positive cocci .