CAJ | 학술논문

目的：了解北京协和医院外科住院患者临床分离细菌分布及对抗菌药物的耐药性。方法收集2012年1月1日至2013年12月31日北京协和医院外科住院患者临床分离的3084株非重复细菌，采用纸片扩散法或自动化仪器法进行药敏试验，按美国临床实验室标准化协会2013年版标准判读药敏结果，采用 WHONET 5.6软件进行数据分析。结果3084株非重复细菌中，10种最常见的细菌依次为鲍曼不动杆菌（14.1％）、大肠埃希菌（12.4％）、铜绿假单胞菌（12.4％）、肺炎克雷伯菌（11.8％）、金黄色葡萄球菌（8.9％）、粪肠球菌（5.4％）、凝固酶阴性葡萄球菌（5.3％）、阴沟肠杆菌（3.7％）、嗜麦芽窄食单胞菌（3.6％）和屎肠球菌（3.2％），其中革兰阴性菌占71.6％（2208株），革兰阳性菌占28.4％（876株）。耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aureus， MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（ methicillin-resistant coagulase-negative Staphylococcus， MRCNS ）的检出率分别为42.7％（117／274）和77.3％（119／154）。 MRSA和MRCNS对β-内酰胺类和其他抗菌药物的耐药率明显高于甲氧西林敏感金黄色葡萄球菌（methicillin-susceptible Staphylococcus aureus， MSSA）和甲氧西林敏感凝固酶阴性葡萄球菌（methicillin-susceptible coagulase-negative Staphylococcus， MSCNS）。 MRSA中80.3％菌株对磺胺甲噁唑-甲氧苄啶敏感， MRCNS中95.0％菌株对利福平敏感。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。粪肠球菌对大多数抗菌药物的耐药率明显低于屎肠球菌，但后者对氯霉素的耐药率较低，仅为4.3％。分别发现1株和5株万古霉素耐药的粪肠球菌和屎肠球菌。未发现对利奈唑胺耐药的肠球菌。产超广谱β-内酰胺酶（ extended spectrum β-lactamases， ESBLs）的大肠埃希菌、克雷伯菌属细菌（肺炎克雷伯菌和产酸克雷伯菌）和奇异变形杆菌的检出率分别为56.7％（217／383）、23.8％（97／408）和22.8％（13／57）。产ESBLs菌株的耐药率明显高于非产 ESBLs 菌株。肠杆菌科细菌对碳青霉烯类抗菌药物仍高度敏感，总耐药率1.6％～3.3％。泛耐药肺炎克雷伯菌的检出率为0.8％（3／363）。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为19.5％和15.0％，对阿米卡星的耐药率最低（8.6％）；鲍曼不动杆菌对上述两种抗菌药物的耐药率分别为74.1％和74.0％，对米诺环素和头孢哌酮-舒巴坦的耐药率最低（28.9％和51.5％）。泛耐药鲍曼不动杆菌和铜绿假单胞菌的检出率分别为44.3％（193／436）和0.8％（3／381）。结论定期进行耐药性监测有助于了解细菌耐药性变迁，为临床经验用药提供依据。目的：瞭解北京協和醫院外科住院患者臨床分離細菌分佈及對抗菌藥物的耐藥性。方法收集2012年1月1日至2013年12月31日北京協和醫院外科住院患者臨床分離的3084株非重複細菌，採用紙片擴散法或自動化儀器法進行藥敏試驗，按美國臨床實驗室標準化協會2013年版標準判讀藥敏結果，採用 WHONET 5.6軟件進行數據分析。結果3084株非重複細菌中，10種最常見的細菌依次為鮑曼不動桿菌（14.1％）、大腸埃希菌（12.4％）、銅綠假單胞菌（12.4％）、肺炎剋雷伯菌（11.8％）、金黃色葡萄毬菌（8.9％）、糞腸毬菌（5.4％）、凝固酶陰性葡萄毬菌（5.3％）、陰溝腸桿菌（3.7％）、嗜麥芽窄食單胞菌（3.6％）和屎腸毬菌（3.2％），其中革蘭陰性菌佔71.6％（2208株），革蘭暘性菌佔28.4％（876株）。耐甲氧西林金黃色葡萄毬菌（methicillin-resistant Staphylococcus aureus， MRSA）和耐甲氧西林凝固酶陰性葡萄毬菌（ methicillin-resistant coagulase-negative Staphylococcus， MRCNS ）的檢齣率分彆為42.7％（117／274）和77.3％（119／154）。 MRSA和MRCNS對β-內酰胺類和其他抗菌藥物的耐藥率明顯高于甲氧西林敏感金黃色葡萄毬菌（methicillin-susceptible Staphylococcus aureus， MSSA）和甲氧西林敏感凝固酶陰性葡萄毬菌（methicillin-susceptible coagulase-negative Staphylococcus， MSCNS）。 MRSA中80.3％菌株對磺胺甲噁唑-甲氧芐啶敏感， MRCNS中95.0％菌株對利福平敏感。未髮現對萬古黴素、替攷拉寧和利奈唑胺耐藥的葡萄毬菌。糞腸毬菌對大多數抗菌藥物的耐藥率明顯低于屎腸毬菌，但後者對氯黴素的耐藥率較低，僅為4.3％。分彆髮現1株和5株萬古黴素耐藥的糞腸毬菌和屎腸毬菌。未髮現對利奈唑胺耐藥的腸毬菌。產超廣譜β-內酰胺酶（ extended spectrum β-lactamases， ESBLs）的大腸埃希菌、剋雷伯菌屬細菌（肺炎剋雷伯菌和產痠剋雷伯菌）和奇異變形桿菌的檢齣率分彆為56.7％（217／383）、23.8％（97／408）和22.8％（13／57）。產ESBLs菌株的耐藥率明顯高于非產 ESBLs 菌株。腸桿菌科細菌對碳青黴烯類抗菌藥物仍高度敏感，總耐藥率1.6％～3.3％。汎耐藥肺炎剋雷伯菌的檢齣率為0.8％（3／363）。銅綠假單胞菌對亞胺培南和美囉培南的耐藥率分彆為19.5％和15.0％，對阿米卡星的耐藥率最低（8.6％）；鮑曼不動桿菌對上述兩種抗菌藥物的耐藥率分彆為74.1％和74.0％，對米諾環素和頭孢哌酮-舒巴坦的耐藥率最低（28.9％和51.5％）。汎耐藥鮑曼不動桿菌和銅綠假單胞菌的檢齣率分彆為44.3％（193／436）和0.8％（3／381）。結論定期進行耐藥性鑑測有助于瞭解細菌耐藥性變遷，為臨床經驗用藥提供依據。
목적：료해북경협화의원외과주원환자림상분리세균분포급대항균약물적내약성。방법수집2012년1월1일지2013년12월31일북경협화의원외과주원환자림상분리적3084주비중복세균，채용지편확산법혹자동화의기법진행약민시험，안미국림상실험실표준화협회2013년판표준판독약민결과，채용 WHONET 5.6연건진행수거분석。결과3084주비중복세균중，10충최상견적세균의차위포만불동간균（14.1％）、대장애희균（12.4％）、동록가단포균（12.4％）、폐염극뢰백균（11.8％）、금황색포도구균（8.9％）、분장구균（5.4％）、응고매음성포도구균（5.3％）、음구장간균（3.7％）、기맥아착식단포균（3.6％）화시장구균（3.2％），기중혁란음성균점71.6％（2208주），혁란양성균점28.4％（876주）。내갑양서림금황색포도구균（methicillin-resistant Staphylococcus aureus， MRSA）화내갑양서림응고매음성포도구균（ methicillin-resistant coagulase-negative Staphylococcus， MRCNS ）적검출솔분별위42.7％（117／274）화77.3％（119／154）。 MRSA화MRCNS대β-내선알류화기타항균약물적내약솔명현고우갑양서림민감금황색포도구균（methicillin-susceptible Staphylococcus aureus， MSSA）화갑양서림민감응고매음성포도구균（methicillin-susceptible coagulase-negative Staphylococcus， MSCNS）。 MRSA중80.3％균주대광알갑오서-갑양변정민감， MRCNS중95.0％균주대리복평민감。미발현대만고매소、체고랍저화리내서알내약적포도구균。분장구균대대다수항균약물적내약솔명현저우시장구균，단후자대록매소적내약솔교저，부위4.3％。분별발현1주화5주만고매소내약적분장구균화시장구균。미발현대리내서알내약적장구균。산초엄보β-내선알매（ extended spectrum β-lactamases， ESBLs）적대장애희균、극뢰백균속세균（폐염극뢰백균화산산극뢰백균）화기이변형간균적검출솔분별위56.7％（217／383）、23.8％（97／408）화22.8％（13／57）。산ESBLs균주적내약솔명현고우비산 ESBLs 균주。장간균과세균대탄청매희류항균약물잉고도민감，총내약솔1.6％～3.3％。범내약폐염극뢰백균적검출솔위0.8％（3／363）。동록가단포균대아알배남화미라배남적내약솔분별위19.5％화15.0％，대아미잡성적내약솔최저（8.6％）；포만불동간균대상술량충항균약물적내약솔분별위74.1％화74.0％，대미낙배소화두포고동-서파탄적내약솔최저（28.9％화51.5％）。범내약포만불동간균화동록가단포균적검출솔분별위44.3％（193／436）화0.8％（3／381）。결론정기진행내약성감측유조우료해세균내약성변천，위림상경험용약제공의거。
Objective To investigate the distribution and antimicrobial resistance of clinical isolates from surgery wards in Peking Union Medical College Hospital ( PUMCH ) .Methods A total of 3084 non-duplicate clinical isolates were collected from PUMCH surgery wards during the period from January 1, 2012 to December 31, 2013.Disc diffusion test (Kirby-Bauer method) and automated systems were employed to detect the antimicrobial resistance of these isolates .The data were analyzed by WHONET 5.6 software according to Clinical and Laboratory Standards Institute 2013 breakpoints.Results Of the 3084 clinical isolates, the 10 most common bacteria isolated were:A.baumannii (14.1%), E.coli (12.4%), P.aeruginosa (12.4%), K.pneumonia (11.8%), S.aureus (8.9%), E.faecalis (5.4%), coagulase-negative staphylococcus (5.3%), E.cloacae (3.7%), S.maltophilia (3.6%) and E.faecium ( 3.2%) , in which gram-negative bacteria accounted for 71.6% ( 2208 isolates ) and gram-positive accounted for 28.4%(876 isolates).In S.aureus and coagulase-negative staphylococcus, methicil-lin-resistant strains ( MRSA and MRCNS ) accounted for 42.7%(117/274) and 77.3%(119/154) , respectively . The resistance rates of methicillin-resistance strains to β-lactams and other antimicrobial agents were much higher than those of methicillin-susceptive strains including methicillin-susceptible Staphylococcus aureus ( MSSA ) and methicillin-susceptible coagulase-negative Staphylococcus (MSCNS).In addition, 80.3% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole , while 95.0%of MRCNS strains were susceptible to rifampin .No staphylococcal strains were found resistant to vancomycin , teicoplanin, or linezolid.The drug resistance rates of E.faecalis strains to most antimicrobials tested were much lower than those of E.faecium, except for the resistance rate to chloramphenicol , which was only 4.3%in E.faecium.One strain of E.faecalis and 5 strains of E.faecium were found resistant to vancomycin .No linezolid-resistant strains were found in enterococcal isolates .Extended spectrum β-lactamases ( ESBLs )-producing strains accounted for 56.7% ( 217/383 ) , 23.8% ( 97/408 ) , and 22.8%(13/57) in E.coli, Klebsiella species (K.pneumoniae and K.oxytoca), and P.mirabilis, respectively. The drug resistance rates of ESBLs-producing strains were higher than the corresponding non-ESBLs-producing strains.Enterobacteriaceae strains were still highly susceptible to carbapenems , the overall resistance rates being 1.6%-3.3%.A few pan-resistant strains of K.pneumoniae ( 0.8%, 3/363 ) were identified .The resistance rates of P.aeruginosa to imipenem and meropenem were 19.5%and 15.0%, respectively , while the resistance rate to amikacin was the lowest ( 8.6%) .The resistance rates of A.baumannii to imipenem and meropenem were 74.1%and 74.0%, respectively , compared with the lowest resistance rates to cefoperazone-sulbactam (51.5%) and minocycline (28.9%) .The prevalence of pan-resistant strains in A.baumannii and P.aeruginosa were 44.3%(193/436) and 0.8%(3/381), respectively.Conclusion Regular surveillance of bacterial resistance could pro-vide practical guidance of rational selection of antimicrobial agents for clinicians .