CAJ | 학술논문

目的：了解北京协和医院2013年临床分离细菌对抗菌药物的耐药性。方法收集2013年1月1日至12月31日北京协和医院临床分离的7236株非重复细菌，采用纸片扩散法或自动化仪器法进行药敏试验，按美国临床实验室标准化协会2013年版标准判读药敏结果，采用WHONET5.6软件进行数据分析。结果7236株非重复的细菌中，革兰阴性菌占71.1％（5147株），革兰阳性菌占28.9％（2089株）。耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphalococcus aureus， MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（ methicillin-resistant coagulase-negative Staphylococcus， MRCNS）的检出率分别为34.9％（244/700）和67.2％（123/183）。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。发现少数万古霉素和替考拉宁耐药的屎肠球菌，未发现对利奈唑胺耐药的肠球菌。产超广谱β-内酰胺酶（ extended spectrumβ-lacta-mases， ESBLs）的大肠埃希菌、克雷伯菌属细菌（肺炎克雷伯菌和产酸克雷伯菌）和奇异变形杆菌的检出率分别为49.5％（698/1410）、25.4％（235/925）和22.6％（30/133）。肠杆菌科细菌对碳青霉烯类抗菌药物仍高度敏感，总耐药率1.5％～2.3％。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为19.4％和15.6％。鲍曼不动杆菌对上述两种抗菌药物的耐药率分别为70.9％和72.0％。泛耐药鲍曼不动杆菌的检出率为42.9％（306/714）。结论细菌耐药性仍是临床重要问题，特别是泛耐药鲍曼不动杆菌，应采取有效的医院感染控制措施和合理使用抗菌药物。
목적：료해북경협화의원2013년림상분리세균대항균약물적내약성。방법수집2013년1월1일지12월31일북경협화의원림상분리적7236주비중복세균，채용지편확산법혹자동화의기법진행약민시험，안미국림상실험실표준화협회2013년판표준판독약민결과，채용WHONET5.6연건진행수거분석。결과7236주비중복적세균중，혁란음성균점71.1％（5147주），혁란양성균점28.9％（2089주）。내갑양서림금황색포도구균（methicillin-resistant Staphalococcus aureus， MRSA）화내갑양서림응고매음성포도구균（ methicillin-resistant coagulase-negative Staphylococcus， MRCNS）적검출솔분별위34.9％（244/700）화67.2％（123/183）。미발현대만고매소、체고랍저화리내서알내약적포도구균。발현소수만고매소화체고랍저내약적시장구균，미발현대리내서알내약적장구균。산초엄보β-내선알매（ extended spectrumβ-lacta-mases， ESBLs）적대장애희균、극뢰백균속세균（폐염극뢰백균화산산극뢰백균）화기이변형간균적검출솔분별위49.5％（698/1410）、25.4％（235/925）화22.6％（30/133）。장간균과세균대탄청매희류항균약물잉고도민감，총내약솔1.5％～2.3％。동록가단포균대아알배남화미라배남적내약솔분별위19.4％화15.6％。포만불동간균대상술량충항균약물적내약솔분별위70.9％화72.0％。범내약포만불동간균적검출솔위42.9％（306/714）。결론세균내약성잉시림상중요문제，특별시범내약포만불동간균，응채취유효적의원감염공제조시화합리사용항균약물。
Objective To investigate the antimicrobial resistance of bacteria isolated from clinical samples in Peking Union Medical College Hospital in 2013 .Methods A total of 7236 nonduplicate clinical isolates were collected from January 1 to December 31 , 2013 .Disk diffusion test ( Kirby-Bauer method ) and automated sys-tems were employed to test the antimicrobial resistance of these isolates .The data were analyzed using WHONET 5.6 software and judged according to the Clinical and Laboratory Standards Institute guideline 2013 .Results Of the 7236 nonduplicate clinical isolates , Gram-negative and Gram-positive bacteria accounted for 71.1%(5147) and 28.9%(2089), respectively.Methicillin-resistant Staphalococcus aureus (MRSA) accounted for 34.9%(244/700) and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) accounted for 67.2% (123/183 ) of Staphalococcus aureus isolates .No staphylococcus strains resistant to vancomycin , teicoplanin , or linezol-id were detected .A few strains of Enterococcus faecium were found resistant to vancomycin and teicoplanin .No linezolid-resistant enterococcus strains were found .Extended spectrum β-lactamases ( ESBLs )-producing strains accounted for 49.5%(698/1410), 25.4% (235/925) and 22.6% (30/133) in Escherichia coli, Klebsiella species ( K.pneumoniae and K.oxytoca) and Proteus mirabilis, respectively .The Enterobacteriaceae strains were still highly sensitive to carbapenems , with only 1.5%-2.3%resistant to carbapenems .The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 19.4% and 15.6%, respectively .The resistance rates of Acinetobacter baumannii to these two antimicrobials were 70.9% and 72.0%, respectively .The preva-lence of pan-resistant strains in Acinetobacter baumannii was 42.9% ( 306/714 ) .Conclusions Antimicrobial resistance is still a serious problem , especially pan-resistant Acinetobacter baumannii strains.It is mandatory to take effective measures controlling nosocomial infection and ensuring rational antimicrobial use .