CAJ | 학술논문

目的：统计医院患者细菌感染菌群的变化以及耐药情况，为医院内感染管理和临床合理用药提供参考依据。方法常规培养分离临床标本，采用梅里埃公司的VITEK2全自动微生物分析仪，对标本进行细菌鉴定和药敏分析。药敏确证实验，采用美国临床检验室标准化委员会（Clinical and Laboratory Standards Institute ，CLSI）推荐的纸片扩散法，进行确证实验。结果2011～2013年医院感染的细菌标本来源以痰液、分泌物和中段尿为主；且感染的主要细菌呈上升趋势，排在前五位的细菌分别是：大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和金黄色葡萄球菌；常见的多重耐药菌，排前三位的是鲍曼不动杆菌、铜绿假单胞菌和大肠埃希菌，其在3年中的构成比有小幅度的增加；3年中革兰阴性杆菌（G－）耐药率大于70％的抗菌药物有：氨苄西林、头孢呋辛钠和头孢呋辛酯；革兰阳性球菌（G＋）耐药率大于70％的抗菌药物有：青霉素G和红霉素。除4例粪肠球菌外，没发现其他耐万古霉素的菌株。结论细菌感染的标本来源以痰液为主。革兰阴性杆菌是医院感染的主要致病菌，呈每年递增的趋势，多重耐药菌株也不断上升，青霉素类药物已不适用于临床细菌感染的治疗；亚胺培南对大肠埃希菌和肺炎克雷伯有很高的敏感性。医院应高度重视感染的管理，加强抗菌药物应用的监管，减少细菌感染的爆发和流行，减少耐药菌株的增加。
목적：통계의원환자세균감염균군적변화이급내약정황，위의원내감염관리화림상합리용약제공삼고의거。방법상규배양분리림상표본，채용매리애공사적VITEK2전자동미생물분석의，대표본진행세균감정화약민분석。약민학증실험，채용미국림상검험실표준화위원회（Clinical and Laboratory Standards Institute ，CLSI）추천적지편확산법，진행학증실험。결과2011～2013년의원감염적세균표본래원이담액、분비물화중단뇨위주；차감염적주요세균정상승추세，배재전오위적세균분별시：대장애희균、폐염극뢰백균、포만불동간균、동록가단포균화금황색포도구균；상견적다중내약균，배전삼위적시포만불동간균、동록가단포균화대장애희균，기재3년중적구성비유소폭도적증가；3년중혁란음성간균（G－）내약솔대우70％적항균약물유：안변서림、두포부신납화두포부신지；혁란양성구균（G＋）내약솔대우70％적항균약물유：청매소G화홍매소。제4례분장구균외，몰발현기타내만고매소적균주。결론세균감염적표본래원이담액위주。혁란음성간균시의원감염적주요치병균，정매년체증적추세，다중내약균주야불단상승，청매소류약물이불괄용우림상세균감염적치료；아알배남대대장애희균화폐염극뢰백유흔고적민감성。의원응고도중시감염적관리，가강항균약물응용적감관，감소세균감염적폭발화류행，감소내약균주적증가。
Objective To statistically analyze the bacterial flora change and drug resistance situation in the patients with bacteri‐al infection to provide reference for clinical rational drug use and the management of nosocomial infection .Methods The clinical samples were conventionally isolated and cultured .The bacteria identification and drug sensitivity test were performed by using the bioMerieux company VITEK2 automatic microorganism analyzer .The confirmation test of drug susceptibility adopted the disk dif‐fusion method recommended by the American Clinical and Laboratory Standardization Committee (CLSI) .Results The sample sources in the hospital infection during 2011-2013 were main sputum ,secretions and midstream urine ;the main infectious bacteria showed the increasing trend ,the top 5 of bacteria were :Escherichia coli (ECO) ,Klebsiella pneumoniae (KPN) ,Acinetobacter bau‐manii (ABA) ,Pseudomonas aeruginosa (PAE) ,Staphylococcus aureus (SAU);the top three of common multi‐drug resistant bacte‐ria were ABA ,PAE and ECO ,their constituent ratio during these three years had a small amplitude increase ;the antibiotics for Gram negative bacilli (G -) resistance rate of more than 70% during these 3 years were :ampicillin ,cefuroxime sodium and cefu‐roxime axetil;the antibiotics for Gram positive cocci (G+ ) resistance rate of more than 70% during these 3 years were penicillin and erythromycin ..Except for 4 cases of Enterococcus faecalis ,no other vancomycin‐resistant strains were found .Conclusion The sam‐ple source of bacterial infection is dominated by sputum ,the gram negative bacteria are the main force of hospital infection ,showing a increasing trend every year ,multi- drug resistant strains are also continuously rising ,penicillin is unsuitable to the clinical treat‐ment of bacterial infection ;imipenem has very high sensitivity to ECO and KPN .The hospital should attach great importance to the infection management ,strengthen the application and management of antibiotics ,decrease the outbreak and prevalence of bacterial infection and reduce the increase of drug resistant strains .