海南医学
海南醫學
해남의학
HAINAN MEDICAL JOURNAL
2015年
1期
59-63
,共5页
杨政%胡勤明%杨忠民%袁喆
楊政%鬍勤明%楊忠民%袁喆
양정%호근명%양충민%원철
细菌%抗菌药物%耐药性监测%药敏试验
細菌%抗菌藥物%耐藥性鑑測%藥敏試驗
세균%항균약물%내약성감측%약민시험
Bacterium%Antibacterial agents%Resistance surveillance%Antibiotic susceptibility test
目的：了解我院临床分离株菌对常用抗菌药物的耐药性，为临床合理使用抗菌药物提供依据。方法采用纸片扩散法进行药敏试验，以CLSI2011年标准判断分离株的敏感性，用WHONET 5.5及SPSS18.0软件分析数据。结果2012年我院共收集临床分离菌株4176株，其中革兰氏阳性菌株1094，占26.2%，革兰氏阴性菌3082株，占73.8%。金黄色葡萄球菌和凝固酶阴性葡萄球菌对甲氧西林的耐药率分别为51.7%和71.7%。肠球菌属中粪肠球菌对氨苄西林、呋喃妥因、磷霉素的耐药率要明显低于屎肠球菌。未发现对万古霉素、替考拉宁、利奈唑胺耐药的葡萄球菌属及肠球菌属。我院大肠埃希菌和肺炎克雷伯菌产ESBLs的比例分别为65.1%和31.3%。肠杆菌科细菌中产ESBLs株对所检测的抗菌药物的耐药率均明显高于非产ESBLs菌株。肠杆菌科细菌对碳青酶烯类药物敏感率极高，耐药率不超过2.2%。我院鲍曼不动杆菌对亚胺培南、美罗培南、头孢哌酮-舒巴坦、米诺环素的耐药率分别为88.6%、84.2%、59.6%、42.6%，其中多重耐药鲍曼不动杆菌的检出率达40.5%。分离的铜绿假单胞菌对三、四代头孢菌素，碳青霉烯类等抗菌药物的耐药率均不超过20.0%。结论我院耐甲氧西林的金葡菌(MRSA)、凝固酶阴性葡萄球菌(MRCNS)、多重耐药鲍曼不动杆菌以及肠杆菌科细菌产ESBLs的检出率极高，应加强细菌耐药性监测和抗菌药物分级管理，合理使用抗菌药物。
目的：瞭解我院臨床分離株菌對常用抗菌藥物的耐藥性，為臨床閤理使用抗菌藥物提供依據。方法採用紙片擴散法進行藥敏試驗，以CLSI2011年標準判斷分離株的敏感性，用WHONET 5.5及SPSS18.0軟件分析數據。結果2012年我院共收集臨床分離菌株4176株，其中革蘭氏暘性菌株1094，佔26.2%，革蘭氏陰性菌3082株，佔73.8%。金黃色葡萄毬菌和凝固酶陰性葡萄毬菌對甲氧西林的耐藥率分彆為51.7%和71.7%。腸毬菌屬中糞腸毬菌對氨芐西林、呋喃妥因、燐黴素的耐藥率要明顯低于屎腸毬菌。未髮現對萬古黴素、替攷拉寧、利奈唑胺耐藥的葡萄毬菌屬及腸毬菌屬。我院大腸埃希菌和肺炎剋雷伯菌產ESBLs的比例分彆為65.1%和31.3%。腸桿菌科細菌中產ESBLs株對所檢測的抗菌藥物的耐藥率均明顯高于非產ESBLs菌株。腸桿菌科細菌對碳青酶烯類藥物敏感率極高，耐藥率不超過2.2%。我院鮑曼不動桿菌對亞胺培南、美囉培南、頭孢哌酮-舒巴坦、米諾環素的耐藥率分彆為88.6%、84.2%、59.6%、42.6%，其中多重耐藥鮑曼不動桿菌的檢齣率達40.5%。分離的銅綠假單胞菌對三、四代頭孢菌素，碳青黴烯類等抗菌藥物的耐藥率均不超過20.0%。結論我院耐甲氧西林的金葡菌(MRSA)、凝固酶陰性葡萄毬菌(MRCNS)、多重耐藥鮑曼不動桿菌以及腸桿菌科細菌產ESBLs的檢齣率極高，應加彊細菌耐藥性鑑測和抗菌藥物分級管理，閤理使用抗菌藥物。
목적：료해아원림상분리주균대상용항균약물적내약성，위림상합리사용항균약물제공의거。방법채용지편확산법진행약민시험，이CLSI2011년표준판단분리주적민감성，용WHONET 5.5급SPSS18.0연건분석수거。결과2012년아원공수집림상분리균주4176주，기중혁란씨양성균주1094，점26.2%，혁란씨음성균3082주，점73.8%。금황색포도구균화응고매음성포도구균대갑양서림적내약솔분별위51.7%화71.7%。장구균속중분장구균대안변서림、부남타인、린매소적내약솔요명현저우시장구균。미발현대만고매소、체고랍저、리내서알내약적포도구균속급장구균속。아원대장애희균화폐염극뢰백균산ESBLs적비례분별위65.1%화31.3%。장간균과세균중산ESBLs주대소검측적항균약물적내약솔균명현고우비산ESBLs균주。장간균과세균대탄청매희류약물민감솔겁고，내약솔불초과2.2%。아원포만불동간균대아알배남、미라배남、두포고동-서파탄、미낙배소적내약솔분별위88.6%、84.2%、59.6%、42.6%，기중다중내약포만불동간균적검출솔체40.5%。분리적동록가단포균대삼、사대두포균소，탄청매희류등항균약물적내약솔균불초과20.0%。결론아원내갑양서림적금포균(MRSA)、응고매음성포도구균(MRCNS)、다중내약포만불동간균이급장간균과세균산ESBLs적검출솔겁고，응가강세균내약성감측화항균약물분급관리，합리사용항균약물。
Objective To investigate the resistance of bacteria isolated from clinic in our hospital, and to pro-vide reference for the rational use of antibiotics in clinical practice. Methods Antimicrobial susceptibility testing was performed with Kirby-Bauer method. All the data were analyzed by WHONET 5.5 and SPSS18.0 softwares ac-cording to the breakpoints of CLSI 2011. Results A total of 4 176 clinical strains were isolated during 2012, of which Gram positive cocci and Gram negative bacilli accounted for 26.2% and 73.8%, respectively. The resistance rates of S. aureus (MRSA) and coagulase negative Staphylococcus (MRCNS) to methicillin were 51.7%and 71.7%, re-spectively. In Enterococcus spp, the resistance rates of E. faecalis strains to ampicillin, macrodantin and fosfomycin were much lower than those of E. faecium. There were no Staphylococcal and Enterococcus spp. strains resistant to van-comycin, teicoplanin or linezolid. The prevalences of ESBLs producing strains were 65.1% in E. coli and 31.3% in Klebsiella spp. ESBLs-prodcing Enterobacteriaceae strains were much more resistant than non-ESBLs-producing strains in respect of antibiotic resistance rate. The Enterobacteriaceae strains were still highly susceptible to car-bapenems, and the resistance rates of these strains to carbapenems were less than 2.2%. The resistance rates of Acinetobacter baumannii in our hospital to imipenem, meropenem, cefperazone-sulbactam and minocycline were 88.6%, 84.2%, 59.6% and 42.6%, respectively. The detection rate of multidrug-resistant Acinetobacter baumannii reached up to 40.5%. Less than 20.0%of Pseudomonas aeruginosa isolates were resistant to third, fourth cephalo-sporin and carbapenems. Conclusion The detection rates of MRSA, MRCNS, multidrug-resistant Acinetobacter baumannii and ESBLs-prodcing Enterobacteriaceae strains in our hospital were surprisingly high. The surveillance of antibiotic resistance and the management of antibacterials grading system should be strengthened, so as to promote the rational use of antimicrobials.
