中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2013年
6期
626-629
,共4页
蒋旭宏%王原%华军益%吕宾
蔣旭宏%王原%華軍益%呂賓
장욱굉%왕원%화군익%려빈
细菌耐药%抗菌药物%慢性阻塞性肺病%细菌分布%急诊科%急性加重%耐药性检测%减少耐药率
細菌耐藥%抗菌藥物%慢性阻塞性肺病%細菌分佈%急診科%急性加重%耐藥性檢測%減少耐藥率
세균내약%항균약물%만성조새성폐병%세균분포%급진과%급성가중%내약성검측%감소내약솔
Bacterial resistance%Antimicrobial agent%Chronic obstructive pulmonary disease%Bacterial distribution%Emergency department%Exacerbation%Surveillance of bacterial resistance%Reduce resistance
目的 研究分析浙江中医药大学附属第一医院急诊科C、D类慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性加重患者细菌感染的分布情况及其耐药性.方法 对急诊科C、D类COPD急性加重患者痰液进行培养+药敏试验,采用VITEK-2 compact微生物分析仪鉴定细菌,采用CLSI制定的纸片扩散法进行细菌耐药分析.结果 在分离出的222株细菌株中,革兰阳性(G+)菌60株,占27.0％,革兰阴性(G-)菌162株,占73.0％.G+菌主要为金黄色葡萄球菌和肺炎链球菌,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为50.00％,耐药率显著高于甲氧西林敏感的金黄色葡萄球菌(MSSA),对万古霉素、利奈唑胺、替加环素均敏感(100％).G-菌主要为铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌,非发酵菌铜绿假单胞菌和鲍曼不动杆菌的耐药率较高,肠杆菌科中大肠埃希菌产超广谱β-内酰胺酶(ESBLs)菌株检出率高于肺炎克雷伯菌,具有多重耐药性.结论 急诊科C、D类COPD急性加重患者的细菌耐药形势严峻,铜绿假单胞菌分离率最高,需加强耐药性检测,及时有效控制感染减少耐药率.
目的 研究分析浙江中醫藥大學附屬第一醫院急診科C、D類慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性加重患者細菌感染的分佈情況及其耐藥性.方法 對急診科C、D類COPD急性加重患者痰液進行培養+藥敏試驗,採用VITEK-2 compact微生物分析儀鑒定細菌,採用CLSI製定的紙片擴散法進行細菌耐藥分析.結果 在分離齣的222株細菌株中,革蘭暘性(G+)菌60株,佔27.0％,革蘭陰性(G-)菌162株,佔73.0％.G+菌主要為金黃色葡萄毬菌和肺炎鏈毬菌,耐甲氧西林金黃色葡萄毬菌(MRSA)檢齣率為50.00％,耐藥率顯著高于甲氧西林敏感的金黃色葡萄毬菌(MSSA),對萬古黴素、利奈唑胺、替加環素均敏感(100％).G-菌主要為銅綠假單胞菌、大腸埃希菌、肺炎剋雷伯菌、鮑曼不動桿菌,非髮酵菌銅綠假單胞菌和鮑曼不動桿菌的耐藥率較高,腸桿菌科中大腸埃希菌產超廣譜β-內酰胺酶(ESBLs)菌株檢齣率高于肺炎剋雷伯菌,具有多重耐藥性.結論 急診科C、D類COPD急性加重患者的細菌耐藥形勢嚴峻,銅綠假單胞菌分離率最高,需加彊耐藥性檢測,及時有效控製感染減少耐藥率.
목적 연구분석절강중의약대학부속제일의원급진과C、D류만성조새성폐질병(chronic obstructive pulmonary disease,COPD)급성가중환자세균감염적분포정황급기내약성.방법 대급진과C、D류COPD급성가중환자담액진행배양+약민시험,채용VITEK-2 compact미생물분석의감정세균,채용CLSI제정적지편확산법진행세균내약분석.결과 재분리출적222주세균주중,혁란양성(G+)균60주,점27.0％,혁란음성(G-)균162주,점73.0％.G+균주요위금황색포도구균화폐염련구균,내갑양서림금황색포도구균(MRSA)검출솔위50.00％,내약솔현저고우갑양서림민감적금황색포도구균(MSSA),대만고매소、리내서알、체가배소균민감(100％).G-균주요위동록가단포균、대장애희균、폐염극뢰백균、포만불동간균,비발효균동록가단포균화포만불동간균적내약솔교고,장간균과중대장애희균산초엄보β-내선알매(ESBLs)균주검출솔고우폐염극뢰백균,구유다중내약성.결론 급진과C、D류COPD급성가중환자적세균내약형세엄준,동록가단포균분리솔최고,수가강내약성검측,급시유효공제감염감소내약솔.
Objective To analyze the bacterial distribution and resistance of clinical isolates from exacerbation of COPD patients in C and D classification in our emergency department.Methods The sputums were taken to culture and antimicrobial susceptibility test.VITEK-2 compact automicrobe system was used to identify bacteria.Disc diffusion test was used to determine the antimicrobial resistance.Results Of 222 clinical isolates,27.0％ were Gram positive bacteria,73.0％ were Gram negative bacteria.The Gram positive bacteria mainly was Staphylococcus aureus and Streptococcus pneumoniae.The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) were 50.00％.The MRSA were more resistant than methicillin-sensitive Staphylococcus aureus (MSSA),and they were all sensitive to vancomycin,linezolid or tigecycline.The Gram negative bacteria mainly was Pseudomonas aeruginosa,Escherichia coli,Klebsiella spp and Acinetobacter baumannii.Pseudomonas aeruginosa and Acinetobacter baumannii had high resistant rates.The extended spectrum β-lactamases (ESBLs) producing strains in Escherichia coli were higher than in Klebsiella spp,which had multiple drug resistance.Conclusions The bacterial resistance situation is very severely in exacerbation of COPD patients in C and D classification in our emergency department.The first isolating rate was Pseudomonas aeruginosa.Surveillance of bacterial resistance is very important and effective control measures to reduce resistance is very necessary.
