CAJ | 학술논문

目的：了解我国青壮年（14～65岁）感染患者病原菌构成及耐药情况。方法收集2012年全国557所三级医院青壮年患者临床分离的细菌，细菌药敏试验用纸片扩散法或自动化仪器测定方法，药敏结果用WHONET 5.6软件进行数据分析。结果共分离细菌383443株，其中革兰氏阴性菌占69.33％，主要菌株依次为大肠埃希菌78915株，肺炎克雷伯菌48698株，铜绿假单胞菌36239株及鲍曼不动杆菌27858株；革兰氏阳性菌占30.67％，主要菌株依次为金黄色葡萄球菌33328株，表皮葡萄球菌18818株，粪肠球菌13114株和屎肠球菌8517株。未发现对万古霉素和利奈唑胺耐药的葡萄球菌；出现对替考拉宁耐药的凝固酶阴性葡萄球菌（3.4％）和万古霉素耐药的屎肠球菌（3.2％）、粪肠球菌（1.5％）。大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌的超广谱β内酰胺酶（ ESBLs）检出率分别为58.4％，33.6％和24.9％，对亚胺培南耐药率比往年有所增加，分别为2.8％，6.5％和4.1％。鲍曼不动杆菌对碳青霉烯类耐药率在50％左右，仅多黏菌素B对其有较好的抗菌活性（96.7％）。嗜血杆菌分离率仍很低，但对各类抗菌药保持很高的敏感性。结论我国青壮年患者临床分离的细菌耐药性较为严重，特别是产ESBLs肠杆菌科细菌，多药耐药非发酵菌，万古霉素耐药的肠球菌的出现及增加，同时历年的耐药变化趋势不同。
목적：료해아국청장년（14～65세）감염환자병원균구성급내약정황。방법수집2012년전국557소삼급의원청장년환자림상분리적세균，세균약민시험용지편확산법혹자동화의기측정방법，약민결과용WHONET 5.6연건진행수거분석。결과공분리세균383443주，기중혁란씨음성균점69.33％，주요균주의차위대장애희균78915주，폐염극뢰백균48698주，동록가단포균36239주급포만불동간균27858주；혁란씨양성균점30.67％，주요균주의차위금황색포도구균33328주，표피포도구균18818주，분장구균13114주화시장구균8517주。미발현대만고매소화리내서알내약적포도구균；출현대체고랍저내약적응고매음성포도구균（3.4％）화만고매소내약적시장구균（3.2％）、분장구균（1.5％）。대장애희균、폐염극뢰백균화기이변형간균적초엄보β내선알매（ ESBLs）검출솔분별위58.4％，33.6％화24.9％，대아알배남내약솔비왕년유소증가，분별위2.8％，6.5％화4.1％。포만불동간균대탄청매희류내약솔재50％좌우，부다점균소B대기유교호적항균활성（96.7％）。기혈간균분리솔잉흔저，단대각류항균약보지흔고적민감성。결론아국청장년환자림상분리적세균내약성교위엄중，특별시산ESBLs장간균과세균，다약내약비발효균，만고매소내약적장구균적출현급증가，동시력년적내약변화추세불동。
Objective To investigate pathogenic bacteria distribution and drug resistance of the bacteria isolated from Chinese young and mid-age patients (14-65 years).Methods Collect and monitor the isolates from young and mid-aged patients (14-65 years) in 557 mem-ber hospitals of Grade three between January 1 and December 31 in 2012.Disk diffusion and automatic machine method are applied to anti-biotic resistance test.The data were analyzed and processed with software WHONET 5.6.Results There are 383443 isolates from young and mid-aged patients in 557 hospitals of Grade three.Gram-negative bac-teria is account for 69.33%, the major strains are Escherichia coli of 78915, Klebsiella pneumoniae of 48698, Pseudomonas aeruginosa of 36239 and Acinetobacter baumannii of 27858, respectively;Gram-posi-tive bacteria is account for 30.67%, Staphylococcus aureus of 33328, Staphylococcus epidermidis of 18818, Enterococcus faecalis of 13114 and Enterococcus faecium of 8517 are the top four.It was not found that Staphylococcus spp.were resistant to vancomycin and linezolid, and there were teicoplanin resistant oagulase -negative Staphylococcus account for 3.4%, Vancomycin resistant Enterococcus faecium 3.2%, Vancomycin resistant Enterococcus faecalis 1.5%.Frequen-cy of extended spectrum beta lactamase ( ESBLs) in Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis are separately 58.4%, 33.6%and 24.9%, which increase resistance to imipenem as 2.8%, 6.5%and 4.1%contrast to last year.Rate of carbapenem resistant to Acinetobacter baumannii was about 50%, only polymixin B has better ac-tivity 96.7%.Haemophilus were isolated less among the young and mid-aged patients, but were sensitive to most an-tibiotic.Conclusion Antibiotic resistant rate of young and mid-aged patients in China are more serious, especially increase of ESBLs producing Enterobacteriaceae, multi drug resistant non-fermenting bacteria and vancomycin resistant Enterococcus.Meanwhile, the resistant trend is various by time, so that it is important and tedious work to monitor the antibiotic resistance.