CAJ | 학술논문

目的：分析我国2012年重症监护病房（ ICU）患者病原菌的分布及其耐药性。方法收集全国557家三级医院ICU分离非重复的细菌，药敏试验按美国实验室标准化协会（CLSI）2012推荐方法进行，用WHONET 5.6软件进行数据分析。结果94178株非重复的细菌中，革兰氏阴性菌占75.6％，革兰氏阳性菌占24.4％。5种最常见的细菌依次为鲍曼不动杆菌（15.8％），肺炎克雷伯菌（14.7％），铜绿假单胞菌（12.8％），大肠埃希菌（12.5％），金黄色葡萄球菌（8.5％）。耐甲氧西林金黄色葡萄球菌（ MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（ MRCNS）的检出率分别为57.5％和83.7％。金黄色葡萄球菌对磺胺甲噁唑／甲氧苄啶敏感率为69.2％，凝固酶阴性葡萄球菌（ CNS）对利福平敏感率为83.9％。未发现对万古霉素，替考拉宁和利奈唑胺耐药的金黄色葡萄球菌。CNS对替考拉宁耐药率为2.1％。粪肠球菌和屎肠球菌对万古霉素，替考拉宁和利奈唑胺的耐药率分别为1.8％，3.1％，2.3％和5.9％，5.9％，1.4％。产超广谱β内酰胺酶（ ESBLs）对大肠埃希菌、肺炎克雷伯菌、产酸克雷伯菌和奇异变形杆菌的检出率分别为67.5％，45.4％，32.5％和39.5％。肠杆菌科细菌对碳青霉烯类耐药率为2.2％～10.4％。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为70.8％和69.2％。铜绿假单胞菌对上述两种抗菌药的耐药率分别为38.5％和37.4％。结论 ICU中细菌对抗菌药的耐药性仍很严重，特别是对碳青霉烯类耐药的肠杆菌细菌和鲍曼不动杆菌，应采取有效的医院感染控制措施和抗菌药的合理使用。
목적：분석아국2012년중증감호병방（ ICU）환자병원균적분포급기내약성。방법수집전국557가삼급의원ICU분리비중복적세균，약민시험안미국실험실표준화협회（CLSI）2012추천방법진행，용WHONET 5.6연건진행수거분석。결과94178주비중복적세균중，혁란씨음성균점75.6％，혁란씨양성균점24.4％。5충최상견적세균의차위포만불동간균（15.8％），폐염극뢰백균（14.7％），동록가단포균（12.8％），대장애희균（12.5％），금황색포도구균（8.5％）。내갑양서림금황색포도구균（ MRSA）화내갑양서림응고매음성포도구균（ MRCNS）적검출솔분별위57.5％화83.7％。금황색포도구균대광알갑오서／갑양변정민감솔위69.2％，응고매음성포도구균（ CNS）대리복평민감솔위83.9％。미발현대만고매소，체고랍저화리내서알내약적금황색포도구균。CNS대체고랍저내약솔위2.1％。분장구균화시장구균대만고매소，체고랍저화리내서알적내약솔분별위1.8％，3.1％，2.3％화5.9％，5.9％，1.4％。산초엄보β내선알매（ ESBLs）대대장애희균、폐염극뢰백균、산산극뢰백균화기이변형간균적검출솔분별위67.5％，45.4％，32.5％화39.5％。장간균과세균대탄청매희류내약솔위2.2％～10.4％。포만불동간균대아알배남화미라배남적내약솔분별위70.8％화69.2％。동록가단포균대상술량충항균약적내약솔분별위38.5％화37.4％。결론 ICU중세균대항균약적내약성잉흔엄중，특별시대탄청매희류내약적장간균세균화포만불동간균，응채취유효적의원감염공제조시화항균약적합리사용。
Objective To investigate the distribution and antimicrobial resistance of clinical isolates derived from intensive care unit(ICU) pa-tients in China in 2012.Methods A total of 94178 non -duplicate clinical isolates from ICU of 557 tertiary hospitals were collected from January 2012 to December 2012.Antimicrobial susceptibility testing was carried out according to a unified using disc diffusion test ( Kirby-Bauer method ) or automated systems.The data were analyzed by WHONET 5.6 software according to Clinical and Laboratory Standards Institute ( CLSI) 2012 breakpoints.Results Among these 94178 non-duplicate clinical isolates, gram-negative organisms and gram-positive organisms accounted for 75.6% and 24.4%, respectively.The 5 most common pathogens in ICU were Acinetobacter baumannii ( 15.8%) , Klebsiella pneumoniae ( 14.7%) , Pseudomonas aeruginosa ( 12.8%) , Escherichia coli ( 12.5%) and Staphylococcus aureus (8.5%).Methicillin -resistant Staphylococcus aureus ( MRSA ) strains and coagulase -negative Staphylococcus ( MRCNS) accounted for 57.5% and 83.7%, respectively.However, 69.2% of Staphylococcus aureus strains were still susceptible to trimethoprim -sulfamethoxazole, while 83.9% of CNS strains were susceptible to rifampin.No Staphylococcus aureus strain was resistant to vancomycin, teicoplanin and linezolid.2.1% of the CNS strains were found resistant to teicoplanin.The resistant rates of Enterococcus faecalis and Enterococcus faecium to vancomycin, teicoplanin and linezolid were 1.8%, 3.1%,2.3% and 5.9%,5.9%1.4%, respectively.Extended spectrum β-lactamases ( ESBLs)-producing strains accounted for 67.5%, 45.4%, 32.5%and 39.5%in Escherichia coli, Kleb-siella pneumoniae, Klebsiella oxytoca and Proteus mirabilis, respectively.Overall, 2.2%-10.4%of the Enterobacteria-ceae strains were resistant to carbapenems.The resistance rates of Acinetobacter baumannii to imipenem and meropenem were 70.8 and 69.2%, respectively.The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 38.5%and 37.4%, respectively.Conclusion Bacterial resistance is still an serious problem in ICU in China, espe-cially the carbapenem resistant Enterbacteriaceae and Acinetobacter baumannii.It is mandatory to take effective hospital infection contral measures and rational use antibiotics.