实用临床医学
實用臨床醫學
실용림상의학
Practical Clinical Medicine
2015年
1期
31-33,55
,共4页
烧伤%革兰阴性菌%多重耐药性%感染%抗菌药物
燒傷%革蘭陰性菌%多重耐藥性%感染%抗菌藥物
소상%혁란음성균%다중내약성%감염%항균약물
burn%gram-negative bacteria%multiple resistance%infection%antibacterial agents
目的：分析烧伤病房革兰阴性多重耐药菌的病原菌分布及耐药性，为临床合理应用抗生素提供依据，并探讨多重耐药菌的防控策略。方法应用 VITEK2-compact全自动微生物鉴定及药敏分析系统对临沂市人民医院烧伤整形科2012年1月至2014年1月送检标本分离的菌株进行菌种鉴定，采用 K-B纸片扩散法进行药敏试验，统计分析革兰阴性多重耐药菌的分布情况及其对抗菌药物的耐药情况。结果共检出130株革兰阴性多重耐药菌，创面分泌物为其主要标本来源，占81．54％，其次为痰液，占12．30％。菌株分布以鲍曼不动杆菌和大肠埃希菌为主，分别占38．46％（50／130）、29．23％（38／130）。大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶（ESBLs）菌株分离率为89．47％（34／38）、87．50％（14／16）。耐碳青霉烯类抗生素鲍曼不动杆菌（CR-AB）对除替加环素、左氧氟沙星之外的所有测试抗菌药物均呈现高度耐药，耐药率在90％～100％之间；肺炎克雷伯菌和大肠埃希菌对碳青霉烯类抗生素、含酶抑制剂的复合制剂、替加环素耐药率均小于20％，而对氨基糖苷类、第三代头孢菌素类、喹诺酮类抗生素耐药率较高。铜绿假单胞菌和阴沟肠杆菌仅对丁胺卡那霉素有较高敏感性。结论革兰阴性多重耐药菌对常用抗菌药物表现出较高耐药性，应及时制定防控策略，缓解细菌耐药性。
目的：分析燒傷病房革蘭陰性多重耐藥菌的病原菌分佈及耐藥性，為臨床閤理應用抗生素提供依據，併探討多重耐藥菌的防控策略。方法應用 VITEK2-compact全自動微生物鑒定及藥敏分析繫統對臨沂市人民醫院燒傷整形科2012年1月至2014年1月送檢標本分離的菌株進行菌種鑒定，採用 K-B紙片擴散法進行藥敏試驗，統計分析革蘭陰性多重耐藥菌的分佈情況及其對抗菌藥物的耐藥情況。結果共檢齣130株革蘭陰性多重耐藥菌，創麵分泌物為其主要標本來源，佔81．54％，其次為痰液，佔12．30％。菌株分佈以鮑曼不動桿菌和大腸埃希菌為主，分彆佔38．46％（50／130）、29．23％（38／130）。大腸埃希菌和肺炎剋雷伯菌產超廣譜β-內酰胺酶（ESBLs）菌株分離率為89．47％（34／38）、87．50％（14／16）。耐碳青黴烯類抗生素鮑曼不動桿菌（CR-AB）對除替加環素、左氧氟沙星之外的所有測試抗菌藥物均呈現高度耐藥，耐藥率在90％～100％之間；肺炎剋雷伯菌和大腸埃希菌對碳青黴烯類抗生素、含酶抑製劑的複閤製劑、替加環素耐藥率均小于20％，而對氨基糖苷類、第三代頭孢菌素類、喹諾酮類抗生素耐藥率較高。銅綠假單胞菌和陰溝腸桿菌僅對丁胺卡那黴素有較高敏感性。結論革蘭陰性多重耐藥菌對常用抗菌藥物錶現齣較高耐藥性，應及時製定防控策略，緩解細菌耐藥性。
목적：분석소상병방혁란음성다중내약균적병원균분포급내약성，위림상합리응용항생소제공의거，병탐토다중내약균적방공책략。방법응용 VITEK2-compact전자동미생물감정급약민분석계통대림기시인민의원소상정형과2012년1월지2014년1월송검표본분리적균주진행균충감정，채용 K-B지편확산법진행약민시험，통계분석혁란음성다중내약균적분포정황급기대항균약물적내약정황。결과공검출130주혁란음성다중내약균，창면분비물위기주요표본래원，점81．54％，기차위담액，점12．30％。균주분포이포만불동간균화대장애희균위주，분별점38．46％（50／130）、29．23％（38／130）。대장애희균화폐염극뢰백균산초엄보β-내선알매（ESBLs）균주분리솔위89．47％（34／38）、87．50％（14／16）。내탄청매희류항생소포만불동간균（CR-AB）대제체가배소、좌양불사성지외적소유측시항균약물균정현고도내약，내약솔재90％～100％지간；폐염극뢰백균화대장애희균대탄청매희류항생소、함매억제제적복합제제、체가배소내약솔균소우20％，이대안기당감류、제삼대두포균소류、규낙동류항생소내약솔교고。동록가단포균화음구장간균부대정알잡나매소유교고민감성。결론혁란음성다중내약균대상용항균약물표현출교고내약성，응급시제정방공책략，완해세균내약성。
Objective To analyze the distribution and antibiotic resistance of multidrug-resist-ant gram-negative bacteria from burn wards,and to provide a basis for rational use of antibiotics and prevention and control of multidrug-resistant bacteria.Methods VITEK2-compact automatic microorganism system and drug sensitivity analyzer were used to identify the pathogens isolated from specimens from patients hospitalized in Department of Burn and Plastic Surgery of Linyi People’s Hospital from January 2012 to January 2014.Drug resistance was tested by K-B paper disk diffusion method.The distribution characteristics and drug resistance of multidrug-resistant gram-negative bacteria were analyzed statistically.Results A total of 130 strains of multidrug-re-sistant gram-negative bacteria were isolated from the specimens.Most of them were isolated from wound secretion (81.54%)and sputum (12.30%).The main pathogenic bacteria isolated were Acinetobacter baumanii (38.46%,50/130)and Escherichia coli (29.23%,38/130).The detection rates of extended-spectrumβ-lactamase-producing Escherichia coli and Klebsiella pneumoniae were 89.47% (34/38)and 87.50% (14/16),respectively.Carbapenem resistant Acinetobacter baumannii isolates were highly resistant to antibacterial agents except tigecycline and levofloxacin (drug resistance rates ranged from 90% to 100%).Escherichia coli and Klebsiella pneumoniae i-solates were sensitive to carbapenems,compound preparation containing enzyme inhibitor and tigecycline (drug resistance rates were less than 20%),but resistant to aminoglycosides,third-generation cephalosporins and quinolones.Pseudomonas aeruginosa and Enterobacter cloacae iso-lates were only sensitive to amikacin sulphate.Conclusion Multidrug-resistant gram-negative bacteria are highly resistant to antibiotics commonly used.Therefore,strategies for the prevention and control of multidrug-resistant gram-negative bacterial infection should be promptly formula-ted to alleviate the bacterial resistance.
