检验医学
檢驗醫學
검험의학
LABORATORY MEDICINE
2015年
5期
474-477
,共4页
耐药基因%多重耐药菌%广泛耐药菌%革兰阴性杆菌%医院感染%老年
耐藥基因%多重耐藥菌%廣汎耐藥菌%革蘭陰性桿菌%醫院感染%老年
내약기인%다중내약균%엄범내약균%혁란음성간균%의원감염%노년
Drug resistant gene%Multi-drug resistant bacterium%Extensively-drug resistant bacterium%Gram negative bacillus%Nosocomial infection%Elder
目的：了解华东医院感染老年患者多重耐药和广泛耐药革兰阴性杆菌耐药性及其分布，为指导临床合理使用抗菌药物和有效预防、控制医院感染提供依据。方法收集华东医院60岁以上老年患者临床标本（痰液、血液、尿液、胆汁及伤口分泌物等）进行细菌培养、鉴定和体外药物敏感性试验；对228例多重耐药和42例广泛耐药革兰阴性杆菌感染的患者资料进行回顾性研究，并用聚合酶链反应（PCR）检测8株广泛耐药的鲍曼不动杆菌的相关耐药基因。结果多重耐药菌排名前3位的是鲍曼不动杆菌、铜绿假单胞菌和大肠埃希菌；广泛耐药菌排名前3位的是鲍曼不动杆菌、铜绿假单胞菌和洋葱伯克霍德菌。广泛耐药的鲍曼不动杆菌检测到了TEM、SHV、PER、ant（2″）－Ⅰ、ant（3″）－Ⅰ、ant（6′）－Ⅰb、OXA－23、gyrA 和 qacEΔ1基因，IMP、VIM 和 OXA－24基因检测为阴性。结论华东医院老年患者医院感染的鲍曼不动杆菌、铜绿假单胞菌耐药情况较为严重，呼吸科和重症监护病房尤其要加强抗菌药物的合理使用并进行细菌耐药性的监测等措施，有效预防、延缓和控制耐药菌株的产生和播散。
目的：瞭解華東醫院感染老年患者多重耐藥和廣汎耐藥革蘭陰性桿菌耐藥性及其分佈，為指導臨床閤理使用抗菌藥物和有效預防、控製醫院感染提供依據。方法收集華東醫院60歲以上老年患者臨床標本（痰液、血液、尿液、膽汁及傷口分泌物等）進行細菌培養、鑒定和體外藥物敏感性試驗；對228例多重耐藥和42例廣汎耐藥革蘭陰性桿菌感染的患者資料進行迴顧性研究，併用聚閤酶鏈反應（PCR）檢測8株廣汎耐藥的鮑曼不動桿菌的相關耐藥基因。結果多重耐藥菌排名前3位的是鮑曼不動桿菌、銅綠假單胞菌和大腸埃希菌；廣汎耐藥菌排名前3位的是鮑曼不動桿菌、銅綠假單胞菌和洋蔥伯剋霍德菌。廣汎耐藥的鮑曼不動桿菌檢測到瞭TEM、SHV、PER、ant（2″）－Ⅰ、ant（3″）－Ⅰ、ant（6′）－Ⅰb、OXA－23、gyrA 和 qacEΔ1基因，IMP、VIM 和 OXA－24基因檢測為陰性。結論華東醫院老年患者醫院感染的鮑曼不動桿菌、銅綠假單胞菌耐藥情況較為嚴重，呼吸科和重癥鑑護病房尤其要加彊抗菌藥物的閤理使用併進行細菌耐藥性的鑑測等措施，有效預防、延緩和控製耐藥菌株的產生和播散。
목적：료해화동의원감염노년환자다중내약화엄범내약혁란음성간균내약성급기분포，위지도림상합리사용항균약물화유효예방、공제의원감염제공의거。방법수집화동의원60세이상노년환자림상표본（담액、혈액、뇨액、담즙급상구분비물등）진행세균배양、감정화체외약물민감성시험；대228례다중내약화42례엄범내약혁란음성간균감염적환자자료진행회고성연구，병용취합매련반응（PCR）검측8주엄범내약적포만불동간균적상관내약기인。결과다중내약균배명전3위적시포만불동간균、동록가단포균화대장애희균；엄범내약균배명전3위적시포만불동간균、동록가단포균화양총백극곽덕균。엄범내약적포만불동간균검측도료TEM、SHV、PER、ant（2″）－Ⅰ、ant（3″）－Ⅰ、ant（6′）－Ⅰb、OXA－23、gyrA 화 qacEΔ1기인，IMP、VIM 화 OXA－24기인검측위음성。결론화동의원노년환자의원감염적포만불동간균、동록가단포균내약정황교위엄중，호흡과화중증감호병방우기요가강항균약물적합리사용병진행세균내약성적감측등조시，유효예방、연완화공제내약균주적산생화파산。
Objective To guide the reasonable antibiotic clinical use and provide the reference for effective prevention and nosocomial infection control by understanding the drug resistance and distribution in elder patients infected with multi-drug resistant and extensively-drug resistant Gram negative bacillus in Huadong Hospital.Methods The data of 228 elder patients infected with multi-drug resistant bacillus and 42 patients infected with extensively-drug resistant bacillus were studied retrospectively ( all the elder patients were over 60 years old).Bacterial culture, identification and drug susceptibility were performed for the specimens from patients ( sputum, blood, urine, bile, wounds secretion and so on).The resistant genes of 8 extensively-drug resistant Acinetobacter baumannii were determined by polymerase chain reaction(PCR).Results The rank of the multi-drug resistant bacillus was Acinetobacter baumannii, Pseudomonas aeruginosa and Escherichia coli, as well as the rank of the extensively-drug resistant bacillus was Acinetobacter baumannii, Pseudomonas aeruginosa and Burkholderia cepacia.The TEM, SHV, PER, ant (2″)-Ⅰ, ant(3″)-Ⅰ, ant(6′)-Ⅰb, OXA-23, gyrA and qacEΔ1 genes were detected in the extensively-drug resistant Acinetobacter baumannii.The results of IMP, VIM and OXA-24 genes were negative.Conclusions Since the severe drug resistance of Acinetobacter baumannii and Pseudomonas aeruginosa from elder patients in Huadong Hospital, especially in the department of respiration and intensive care unit, we should effectively prevent, delay and control the generation and spreading of resistant isolates by strengthening the reasonable antibiotic use as well as monitoring the resistant isolates.
