CAJ | 학술논문

目的：探讨昆明市第一人民医院2002年1月-2011年12月临床分离鲍曼不动杆菌的临床分布、耐药性及变迁情况，指导临床合理用药。方法：采用Microscan Walkaway 40SI鉴定系统辅以传统手工方法鉴定细菌。采用K-B纸片琼脂扩散法进行体外药物敏感性试验，通过Whonet 5.6软件进行耐药性数据分析。结果：2002-2011年鲍曼不动杆菌高发于重症监护室（0～54株），神经外科（4～50株），呼吸科（3～37株），消化科在2003年集中检出45株。检出标本包括痰液（86.2%），肺泡灌洗液（1.5%），血液（1.1%）。2002-2011年所检测的24种抗菌药物耐药率表现为氨苄西林、头孢唑林、头孢西丁10年来持续100%，庆大霉素为52.9%～62.9%，丁胺卡那为12.1%～62.5%，妥布霉素为16.7%～75%，氨苄西林-舒巴坦为0%～61.4%，头孢哌酮-舒巴坦为0%～50%，阿莫西林-克拉维酸为0%～66.9%，哌拉西林-他唑巴坦为33.3%～75%，替卡西林-克拉维酸为14.3%～75%，环丙沙星为42.9%～66.8%，氧氟沙星为57.1%～100%，左氧氟沙星为22.7%～82.4%，哌拉西林为37.5%～75%，头孢哌酮为36.6%～80.8%，头孢曲松为52%～74.1%，头孢他啶为38.2%～75%，头孢吡肟为38.5%～75%，氨曲南为0%～87.5%，亚胺培南为0%～58.8%，美罗培南为0%～12.5%，复方新诺明为20.9%～27.1%，米诺环素为0%～25%。结论：鲍曼不动杆菌分离数量逐年上升，易检出于患者呼吸不畅的科室，抗菌药物耐药严重且呈大幅度上升，并渐显多重耐药特性。
목적：탐토곤명시제일인민의원2002년1월-2011년12월림상분리포만불동간균적림상분포、내약성급변천정황，지도림상합리용약。방법：채용Microscan Walkaway 40SI감정계통보이전통수공방법감정세균。채용K-B지편경지확산법진행체외약물민감성시험，통과Whonet 5.6연건진행내약성수거분석。결과：2002-2011년포만불동간균고발우중증감호실（0～54주），신경외과（4～50주），호흡과（3～37주），소화과재2003년집중검출45주。검출표본포괄담액（86.2%），폐포관세액（1.5%），혈액（1.1%）。2002-2011년소검측적24충항균약물내약솔표현위안변서림、두포서림、두포서정10년래지속100%，경대매소위52.9%～62.9%，정알잡나위12.1%～62.5%，타포매소위16.7%～75%，안변서림-서파탄위0%～61.4%，두포고동-서파탄위0%～50%，아막서림-극랍유산위0%～66.9%，고랍서림-타서파탄위33.3%～75%，체잡서림-극랍유산위14.3%～75%，배병사성위42.9%～66.8%，양불사성위57.1%～100%，좌양불사성위22.7%～82.4%，고랍서림위37.5%～75%，두포고동위36.6%～80.8%，두포곡송위52%～74.1%，두포타정위38.2%～75%，두포필우위38.5%～75%，안곡남위0%～87.5%，아알배남위0%～58.8%，미라배남위0%～12.5%，복방신낙명위20.9%～27.1%，미낙배소위0%～25%。결론：포만불동간균분리수량축년상승，역검출우환자호흡불창적과실，항균약물내약엄중차정대폭도상승，병점현다중내약특성。
Objective: To investigate the clinical distribution , drug resistance and transition of Acinetobacter ba-mannii isolated by the first people hospital of Kunmming city from Jan . 2002 to Dec . 2011 , so as to provide a ref-erence for rational drug use in clinical practice . Methods: MicroScan WalkAway 40SI and conventional bacterial i-dentification assays were adopted for bacterial identification . The drug susceptibility test was conducted by K-B disc method and Whonet 5 . 6 software was used for the data analysis . Results: During 2002 - 2011 Acinetobacter bau-mannii was mostly detected in those departments such as ICU ( 0 ~ 54 strains ) , neurosurgery ( 4 ~ 50 strains ) and respiratory departments ( 3 ~ 37 strains ) . About 45 isolates was detected in digestion department in 2003 . The most numbers of isolates were found from sputum ( 86 . 2%) , balf ( 1 . 5%) and blood ( 1 . 1%) . The drug re-sistant rates of 24 kinds of antibiotics were observed including AMP 100%,CZO 100%,FOX 100%, GEN 52.9% ~62.9%,AMK 12.1% ~ 62.5%,TOB 16.7% ~ 75%,SAM 0% ~ 61.4%,CSL 0% ~ 50%,AMC 0% ~ 66.9%, TZP 33 . 3% ~ 75%, TCC 14 . 3% ~ 75%, CIP 42 . 9% ~ 66 . 8%, OFX 57 . 1% ~ 100%, LVX 22 . 7% ~ 82 . 4%, PIP 37.5% ~ 75%,CFP 36.6% ~ 80.8%,CRO 52% ~ 74.1%,CAZ 38.2% ~ 75%,FEP 38.5% ~ 75%,ATM 0% ~87 . 5%, IMP 0% ~ 58 . 8%, MEM 0% ~ 12 . 5%, SXT 20 . 9% ~ 27 . 1% and MNO 0% ~ 25%. Conclusion: The isolated numbers of Acinetobacter baumannii increased year by year and most were found in the areas where there were patients with shortness of breath . Antimicrobial drug resistance was serious and with an increasing trend , and the characteristics of multidrug resistance was found .