中国临床药理学杂志
中國臨床藥理學雜誌
중국림상약이학잡지
THE CHINESE JOURNAL OF CLINICAL PHARMACOLOGY
2015年
11期
1031-1037
,共7页
血流感染%耐药性%监测
血流感染%耐藥性%鑑測
혈류감염%내약성%감측
blood stream infection%antibiotic resistance%surveillance
目的：了解血流感染病原菌分布及其对常用抗菌药物的耐药性。方法常规方法培养分离血标本中的细菌，病原菌按照常规方法进行鉴定和药敏试验。结果三级医院血流感染共分离病原菌76483株，其中革兰阳性菌33920株（占44.35％），革兰阴性菌42563株（占55.65％）。二级医院共分离病原菌6261株，其中革兰阳性菌3061株（占48.89％），革兰阴性菌3200株（占51.11％）。三级医院和二级医院最常见的革兰阴性病原菌为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、阴沟肠杆菌；最常见的革兰阳性病原菌为凝固酶阴性葡萄球菌、金黄色葡萄球菌、屎肠球菌和粪肠球菌。苛养菌主要有肺炎链球菌700株（0.85％）、流感嗜血杆菌28株（＜0.01％）和β溶血链球菌152株（0.18％）。三级医院甲氧西林耐药金黄色葡萄球菌和甲氧西林耐药凝固酶阴性葡萄球菌的检出率分别为44.4％和78.0％，二级医院为32.5％和71.4％。三级医院和二级医院均未检出对万古霉素和利奈唑胺不敏感的葡萄球菌。葡萄球菌属对阿米卡星、利福平和米诺环素的敏感率高，三级医院和二级医院均超过80.0％。粪肠球菌对青霉素和氨苄西林敏感率均高于80.0％。大肠埃希菌对哌拉西林／他唑巴坦和头孢哌酮／舒巴坦敏感率均高于90.0％，对阿米卡星和头孢西丁敏感率约为80.0％。铜绿假单胞菌对常用抗菌药物都保持了较高的敏感率。鲍曼不动杆菌耐药现象严重，但是对多黏菌素B（三级医院）和头孢哌酮／舒巴坦（二级医院）保持了较高的敏感率（分别为97.6％和76.7％）。结论2012年全国血流感染数据显示，血流感染病原菌革兰阴性菌较多，以大肠埃希菌最为常见。凝固酶阴性葡萄球菌分离率较高。不同的病原菌对常用抗菌药物呈现不同的耐药表型，应根据药敏结果合理选用抗菌药物。
目的：瞭解血流感染病原菌分佈及其對常用抗菌藥物的耐藥性。方法常規方法培養分離血標本中的細菌，病原菌按照常規方法進行鑒定和藥敏試驗。結果三級醫院血流感染共分離病原菌76483株，其中革蘭暘性菌33920株（佔44.35％），革蘭陰性菌42563株（佔55.65％）。二級醫院共分離病原菌6261株，其中革蘭暘性菌3061株（佔48.89％），革蘭陰性菌3200株（佔51.11％）。三級醫院和二級醫院最常見的革蘭陰性病原菌為大腸埃希菌、肺炎剋雷伯菌、銅綠假單胞菌、鮑曼不動桿菌、陰溝腸桿菌；最常見的革蘭暘性病原菌為凝固酶陰性葡萄毬菌、金黃色葡萄毬菌、屎腸毬菌和糞腸毬菌。苛養菌主要有肺炎鏈毬菌700株（0.85％）、流感嗜血桿菌28株（＜0.01％）和β溶血鏈毬菌152株（0.18％）。三級醫院甲氧西林耐藥金黃色葡萄毬菌和甲氧西林耐藥凝固酶陰性葡萄毬菌的檢齣率分彆為44.4％和78.0％，二級醫院為32.5％和71.4％。三級醫院和二級醫院均未檢齣對萬古黴素和利奈唑胺不敏感的葡萄毬菌。葡萄毬菌屬對阿米卡星、利福平和米諾環素的敏感率高，三級醫院和二級醫院均超過80.0％。糞腸毬菌對青黴素和氨芐西林敏感率均高于80.0％。大腸埃希菌對哌拉西林／他唑巴坦和頭孢哌酮／舒巴坦敏感率均高于90.0％，對阿米卡星和頭孢西丁敏感率約為80.0％。銅綠假單胞菌對常用抗菌藥物都保持瞭較高的敏感率。鮑曼不動桿菌耐藥現象嚴重，但是對多黏菌素B（三級醫院）和頭孢哌酮／舒巴坦（二級醫院）保持瞭較高的敏感率（分彆為97.6％和76.7％）。結論2012年全國血流感染數據顯示，血流感染病原菌革蘭陰性菌較多，以大腸埃希菌最為常見。凝固酶陰性葡萄毬菌分離率較高。不同的病原菌對常用抗菌藥物呈現不同的耐藥錶型，應根據藥敏結果閤理選用抗菌藥物。
목적：료해혈류감염병원균분포급기대상용항균약물적내약성。방법상규방법배양분리혈표본중적세균，병원균안조상규방법진행감정화약민시험。결과삼급의원혈류감염공분리병원균76483주，기중혁란양성균33920주（점44.35％），혁란음성균42563주（점55.65％）。이급의원공분리병원균6261주，기중혁란양성균3061주（점48.89％），혁란음성균3200주（점51.11％）。삼급의원화이급의원최상견적혁란음성병원균위대장애희균、폐염극뢰백균、동록가단포균、포만불동간균、음구장간균；최상견적혁란양성병원균위응고매음성포도구균、금황색포도구균、시장구균화분장구균。가양균주요유폐염련구균700주（0.85％）、류감기혈간균28주（＜0.01％）화β용혈련구균152주（0.18％）。삼급의원갑양서림내약금황색포도구균화갑양서림내약응고매음성포도구균적검출솔분별위44.4％화78.0％，이급의원위32.5％화71.4％。삼급의원화이급의원균미검출대만고매소화리내서알불민감적포도구균。포도구균속대아미잡성、리복평화미낙배소적민감솔고，삼급의원화이급의원균초과80.0％。분장구균대청매소화안변서림민감솔균고우80.0％。대장애희균대고랍서림／타서파탄화두포고동／서파탄민감솔균고우90.0％，대아미잡성화두포서정민감솔약위80.0％。동록가단포균대상용항균약물도보지료교고적민감솔。포만불동간균내약현상엄중，단시대다점균소B（삼급의원）화두포고동／서파탄（이급의원）보지료교고적민감솔（분별위97.6％화76.7％）。결론2012년전국혈류감염수거현시，혈류감염병원균혁란음성균교다，이대장애희균최위상견。응고매음성포도구균분리솔교고。불동적병원균대상용항균약물정현불동적내약표형，응근거약민결과합리선용항균약물。
Objective To investigate the distribution and changing pa-ttern of susceptibility in bloodstream infection.Methods The blood cul-ture isolates from 557 tertiary hospitals and 232 second class hospitals were routinely isolated and identified.Antimicrobial susceptibility of these isolates were tested routinely.Results A total of 76483 strains were isolated from blood specimens in the tertiary hospitals during 2012.Gram-positive cocci and gram-negative bacilli accounted for 44.35%and 55.65%, respectively.A total of 6261 strains were isolated from blood specimens in the second-class hospitals during 2012.Gram-po-sitive cocci and gram -negative bacilli accounted for 48.89% and 51.11%, respectively.The most frequent gram-negative bacteria from the tertiary hospitals and the second -class hospitals were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacter cloacae, the most fre-quent gram-positive bacteria were Coagulase-negative Staphylococus, Staphylococus aureus, Enterococcus faecium and Enterococcus faecalis.700 strains of Streptococcus pneumoniae ( 0.8%) , 28 strains of Hemophilus influenza (<0.01%) and 152 strains ofβ-hemolytic Streptococcus(0.18%) were isolated.Prevalence of methicillin-resistant Staphylococcus aureus ( MRSA) and methicillin-resistant coagulase negative staphylococcus( MRSCN) among Staphy-lococus aureus and Coagulase-negative Staphylococus were 44.4%and 78.0% in the tertiary hospitals,but the ratios were 32.5%and 71.4%in the second-class hospitals, respectively.All the isolates were sensitive to Vancomycin and Linezolid in the Staphylococcus spp.The sensitivity rates of Staphylococcus spp to Amikacin, Rifampicin and Mino-cycline were high ( >80.0%).The sensitivity rates of Enterococcus faecalis to Pencillin and Ampicillin were high (>80.0%).Escherichia coli was sensitive to not only Ampicillin/Sulbactam and Piperacillin/tazobactam (>90.0%) , but also Amikacin and Cefoxitin ( about 80.0%).Pseudomonas aeruginosa was sensitive to all of the common antibiotics almost.But it was just the opposite to Acinetobacter baumannii.Polymyxin B and Cefoperazone/Sulbactam were sensitive to Acinetobacter baumannii in the tertiary hospitals and the second-class hospitals, respec-tively(97.6%and 76.7%).Conclusion The datas of 2012 indicated that gram-negative bacilli, especially Esche-richia coli, played an important role in blood stream infections.A large number of Coagulase-negative Staphylococus, Staphylococus aureus were isolated, so we should carry out steps according to the standard criterion strictly to reduce the contamination rate.Because of different results to the common antibiotics for the different microorganism, antibiotics should be prescribed according to bacterial resistance results reasonably.
