CAJ | 학술논문

目的：了解深圳市龙华和光明新区三家三级区属医院铜绿假单胞菌感染的临床分布特征及耐药性，为临床科学用药提供依据。方法收集2013年6月～2014年11月三家三级区属医院各科住院临床标本共3176份，采用梅里埃VITEK-32细菌鉴定仪进行细菌鉴定，铜绿假单胞菌阳性标本采用 K-B 法和微量肉汤稀释法（MIC 法）进行药敏试验，并对检验结果进行统计学处理。结果3176份标本铜绿假单胞菌总分离率为51.16％（1625／3176），其中痰标本为52.8％（858／1625），其次为支气管肺泡灌洗液和脓液分别为20.1％（327／1625）和16.7％（271／1625）。病区主要分布在 ICU、心胸外科和神经外科，分别为41.6％（676／1625），15.9％（259／1625）和19.1％（310／1625）。碳青霉烯类敏感、耐碳青霉烯类和泛耐药铜绿假单胞菌分离率分别为67.1％（1090／1625），31.6％（514／1625）和1.29％（21／1625）。耐碳青霉烯类铜绿假单胞菌的耐药性较碳青霉烯类敏感的严重，除多黏菌素 B 外两者耐药率比较差异有统计学意义（χ2＝12.617～80.654，P ＜0.05～0.001），2例耐碳青霉烯类铜绿假单胞菌对多黏菌素 B 耐药，除阿米卡星、庆大霉素、妥布霉素有较高的敏感度外，其余11种抗菌药物的耐药率均＞60％以上。结论临床上铜绿假单胞菌有很高的分离率，主要来源于呼吸道和 ICU 病区。耐碳青霉烯类铜绿假单胞菌比碳青霉烯敏感的耐药严重，应密切关注耐碳青霉烯铜绿假单胞菌耐药性发展，采取有效的预防传播与感染措施，科学使用抗菌药，杜绝耐碳青霉烯类和泛耐药铜绿假单胞菌的蔓延。
목적：료해심수시룡화화광명신구삼가삼급구속의원동록가단포균감염적림상분포특정급내약성，위림상과학용약제공의거。방법수집2013년6월～2014년11월삼가삼급구속의원각과주원림상표본공3176빈，채용매리애VITEK-32세균감정의진행세균감정，동록가단포균양성표본채용 K-B 법화미량육탕희석법（MIC 법）진행약민시험，병대검험결과진행통계학처리。결과3176빈표본동록가단포균총분리솔위51.16％（1625／3176），기중담표본위52.8％（858／1625），기차위지기관폐포관세액화농액분별위20.1％（327／1625）화16.7％（271／1625）。병구주요분포재 ICU、심흉외과화신경외과，분별위41.6％（676／1625），15.9％（259／1625）화19.1％（310／1625）。탄청매희류민감、내탄청매희류화범내약동록가단포균분리솔분별위67.1％（1090／1625），31.6％（514／1625）화1.29％（21／1625）。내탄청매희류동록가단포균적내약성교탄청매희류민감적엄중，제다점균소 B 외량자내약솔비교차이유통계학의의（χ2＝12.617～80.654，P ＜0.05～0.001），2례내탄청매희류동록가단포균대다점균소 B 내약，제아미잡성、경대매소、타포매소유교고적민감도외，기여11충항균약물적내약솔균＞60％이상。결론림상상동록가단포균유흔고적분리솔，주요래원우호흡도화 ICU 병구。내탄청매희류동록가단포균비탄청매희민감적내약엄중，응밀절관주내탄청매희동록가단포균내약성발전，채취유효적예방전파여감염조시，과학사용항균약，두절내탄청매희류화범내약동록가단포균적만연。
Objective To understand the shenzhen longhua new district and the light district three third district hospital pseudomonas aeruginosa infection the clinical distribution and drug resistance,for clinical provides the basis for scientific and medical treatment.Methods Collected 3 176 clinical specimens in three district hospital from June 2013 to November 2014 and they were done bacteria identification with VITEK-32 bacteria identification instrument of French biomerieux.For pseudomonas aeruginosa specimens using the K-B method and trace the broth dilution method (MIC)to do drug sensitive test,and the inspection results were statistically processed.Results 3 176 specimens pseudomonas aeruginosa isolated total separation rate was 51.16% (1 625/3 176),including respiratory sputum specimens was 52.8% (858/1 625),followed by bronchoalveolar lavage and pus,were 20.1% (327/1 625)and 16.7% (271/1 625).Ward,neurosurgery and thoracic sur-geons are mainly distributed in the ICU,were 41.6% (676/1 625),15.9% (259/1 625)and 19.1% (310/1 625).Carbon penicillium,resistance to carbon alkene sensitive penicillium alkene and extensive drug resistance rate of pseudomonas aerug-inosa isolated were 67.1% (1 090/1 625),31.6% (514/1 625)and 1.29% (21/1 625).Resistance to carbon penicillium al-kene the drug resistance of pseudomonas aeruginosa from penicillium carbon alkene sensitive serious,in addition to the poly-myxin B resistance to both comparative difference was statistically significant (χ2 = 12.617~ 12.617,P <0.05~0.001),2 cases of resistance to carbon penicillium alkene pseudomonas aeruginosa to polymyxin B resistance,in addition to amikacin, gentamycin,tobramycin has high sensitivity,the rest of the 11 kinds of antimicrobial drug resistance to all>60%.Conclusion Clinical pseudomonas aeruginosa had a high separation rate,mainly comes from the respiratory tract and the distribution of the ICU ward.Penicillium carbon alkene resistant pseudomonas aeruginosa than carbon penicillium sensitive resistance was serious,should pay close attention to carbon blue mould resistant pseudomonas aeruginosa resistance development,take effective measures of preventing transmission and infection of scientific use of antimicrobials,put an end to resistance to car-bon penicillium alkene and the spread of drug resistance pseudomonas aeruginosa .