CAJ | 학술논문

目的分析多重耐药菌(MDRB)的分布特点及耐药性.方法采用法国生物梅里埃ATB鉴定仪进行病原菌鉴定,K-B纸片扩散法进行药敏试验,同时根据来源追踪分析其易感因素.结果 9 954份标本中检出MDRB 811株,检出率8.1％；主要MDRB为大肠埃希菌、凝固酶阴性葡萄球菌、克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌、铜绿假单胞菌,后两者出现泛耐菌株；标本来源以呼吸道标本为主,占47.8％,主要分布于ICU病房,占41.8％；多重耐药肠杆菌对碳青霉烯类抗菌药物仍高度敏感,总耐药率＜1.5％,对阿米卡星和酶抑制剂药物耐药率＜30.0％；多重耐药非发酵菌则对碳青霉烯类抗菌药物总耐药率＞77.0％,但对多黏菌素100.0％敏感和对头孢哌酮/舒巴坦保持较大的活性(耐药率＜20.0％)；多重耐药葡萄球菌对万古霉素、替考拉宁和利奈唑胺100.0％敏感,对氯霉素和利福平的耐药率相对较低(＜30.0％)；MDRB对其它抗菌药物呈现较高水平耐药；其易感因素包括高龄、基础疾病多、住院时间超过2周、使用多种广谱抗生素特别是三代头孢超过7d以上以及各种有创操作.结论 MDRB对常用抗菌药物耐药严重,临床医生应高度重视病原学检查和它们之间的耐药谱差异,根据药敏试验结果合理应用抗菌药物.
목적 분석다중내약균(MDRB)적분포특점급내약성.방법 채용법국생물매리애ATB감정의진행병원균감정,K-B지편확산법진행약민시험,동시근거래원추종분석기역감인소.결과 9 954빈표본중검출MDRB 811주,검출솔8.1％；주요MDRB위대장애희균、응고매음성포도구균、극뢰백균、금황색포도구균、포만불동간균、동록가단포균,후량자출현범내균주；표본래원이호흡도표본위주,점47.8％,주요분포우ICU병방,점41.8％；다중내약장간균대탄청매희류항균약물잉고도민감,총내약솔＜1.5％,대아미잡성화매억제제약물내약솔＜30.0％；다중내약비발효균칙대탄청매희류항균약물총내약솔＞77.0％,단대다점균소100.0％민감화대두포고동/서파탄보지교대적활성(내약솔＜20.0％)；다중내약포도구균대만고매소、체고랍저화리내서알100.0％민감,대록매소화리복평적내약솔상대교저(＜30.0％)；MDRB대기타항균약물정현교고수평내약；기역감인소포괄고령、기출질병다、주원시간초과2주、사용다충엄보항생소특별시삼대두포초과7d이상이급각충유창조작.결론 MDRB대상용항균약물내약엄중,림상의생응고도중시병원학검사화타문지간적내약보차이,근거약민시험결과합리응용항균약물.
Objective To provide an effective basis for clinical control methods of multi-drug-resistant bacterial (MDRB) infections by analyzing the distribution and antimicrobial resistance of MDRB.Methods The French Merieux ATB Expression Automated Analysis System was used for bacterial identification,whereas a drug susceptibility testing was performed by K-B methods.Drug-resistance rate was calculated,and the predisposing factors were analyzed.Results Altogether 811(8.1％) strains were isolated from 9 954 specimens,and the majority of multiply antimircobial-resistant bacteria were Escherichia coli,Coagulase-negative staphylococci,Klebsiella Pneumoniae Staphylococcus aureus,Acinetobacter Baumannii,Pseudommonas aeruginosa,whereas the last two appeared pan resistant strains.Specimen source was mainly from respiratory specimens,accounted for 47.8％,and was mainly distributed in the ICU unit,atout41.8％ ;MDRB enterobacter was highly sensitive to Carbapenems with resistance rates less than 1.5％ and to Amikacin and other inhibitor drugs that rate was less than 30.0％.The resistance rates of MDRB nonfermentative bacteria was ＞ 77.0％ to Carbapenem antibacterial drugs whereas to non-resistance was found to polymyxin and only 20.0％ resistance rate to Cefoperazone/sulbactam.MDRB staphylococcus was 100.0％ sensitive to Vancomyci,Teicoplanin and Linezolid and less sensitive (＜ 30.0％) to chloramphenicol and rifampicin.MDRB showed high resistance rate to other antibacterial drugs.The predisposing factors included age,other disease,hospitalization over two weeks,the usage of multiply antimicrobial especially cephalosporins overtoppinh 7 days,and invasive operations.Conclusion The major MDRBs are resistant to common-used antimicrobial drugs.It is nesessary to pay attention to the differences.