CAJ | 학술논문

目的：分析2012年我国65岁以上老年患者病原菌分布和细菌耐药特点。方法全国557家三级医院和232家二级医院进行目标细菌收集、鉴定和药敏试验，依据美国实验室标准化协会（ CLSI）2012年标准，用WHONET 5.6软件进行分析和总结。结果共分离出295649株病原菌，排在前5位依次是大肠埃希菌（18.6％），肺炎克雷伯菌（14.6％），铜绿假单胞菌（11.9％），鲍曼不动杆菌（10.6％），金黄色葡萄球菌（6.4％）。大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌超广谱β内酰胺酶（ ESBLs）的产生率分别达到了61.8％，34.7％和28.5％。肠杆菌科对碳青霉烯类敏感性＞90％，此外肠杆菌科对哌拉西林／他唑巴坦和头孢哌酮／舒巴坦也有较好的活性，耐药率均＜12.0％。铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为28.5％和48.5％，而对多黏菌素B和头孢哌酮／舒巴坦有较好的抗菌作用。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51.2％和85.1％。未发现对万古霉素和利奈唑胺耐药的葡萄球菌，仅凝固酶阴性葡萄球菌对替考拉宁产生耐药（2.2％）。肠球菌对万古霉素、利奈唑胺和替考拉宁的耐药率均在3.8％以下。对青霉素肺炎链球菌耐药率为4.9％。结论65岁老年患者感染以革兰氏阴性菌为主，且多重耐药现象严重，急需加强细菌耐药监测，控制耐药菌的发展与传播。
목적：분석2012년아국65세이상노년환자병원균분포화세균내약특점。방법전국557가삼급의원화232가이급의원진행목표세균수집、감정화약민시험，의거미국실험실표준화협회（ CLSI）2012년표준，용WHONET 5.6연건진행분석화총결。결과공분리출295649주병원균，배재전5위의차시대장애희균（18.6％），폐염극뢰백균（14.6％），동록가단포균（11.9％），포만불동간균（10.6％），금황색포도구균（6.4％）。대장애희균、폐염극뢰백균화기이변형간균초엄보β내선알매（ ESBLs）적산생솔분별체도료61.8％，34.7％화28.5％。장간균과대탄청매희류민감성＞90％，차외장간균과대고랍서림／타서파탄화두포고동／서파탄야유교호적활성，내약솔균＜12.0％。동록가단포균화포만불동간균대아알배남적내약솔분별위28.5％화48.5％，이대다점균소B화두포고동／서파탄유교호적항균작용。내갑양서림금황색포도구균（ MRSA）화내갑양서림응고매음성포도구균（ MRCNS）적검출솔분별위51.2％화85.1％。미발현대만고매소화리내서알내약적포도구균，부응고매음성포도구균대체고랍저산생내약（2.2％）。장구균대만고매소、리내서알화체고랍저적내약솔균재3.8％이하。대청매소폐염련구균내약솔위4.9％。결론65세노년환자감염이혁란씨음성균위주，차다중내약현상엄중，급수가강세균내약감측，공제내약균적발전여전파。
Objective To analyze the distribution and drug resistance characteristics of isolates from patients age more than 65 years in 2012 in China.Methods All the clinical strains were collected and the suscep-tibility tests were performed in the third class A level 557 hospitals and the second class A level 232 hospitals around China.The susceptibilities of isolates to antimicrobial agents were determined by using clinical and laboratory standards institute(2012) standards and the susceptibility data were processed with WHONET 5.6 software by centre laboratory.Results A total of 295649 isolates were collected from patients age more than 65 years.The most predominant pathogens were Escherichia coli ( 18.6%) , Klebsiella pneumonia ( 14.6%) , Pseudomonas aeruginosa ( 11.9%) , Acinetobacter baumannii ( 10.6%) , Staphyloccous aureus (6.4%).Extended -spectrum β-lactamases -producing rates of Escherichia coli, Klebsiella pneumonia and Proteus mirabilis were 61.8%、34.7% and 28.5%.A vast majority of Enterobacteriaceae maintained high susceptibility rate to carbopenems over 90%.In addition, Piperacillin/tazobactam and cefoperazone/sulbactam displayed desirable antibacterial activity against Enterobacteriaceae, and resistance rates to these drugs were all below 12%.For non-fermenting gram-negative isolates, resistance rate of Pseudomonas aeruginosa and Acinetobacter baumannii to imipenem were 28.5% and 48.5% respectively.However, polymyxin B and cefoperazone/sulbactam de-monstrated good antibacterial activity against non-fermenters.The prevalence of methicillin resistance Staphyloccous au-reus(MRSA) and methicillin resistance coagulase negative Staphylococcus(MRCNS) reached 51.2%and 85.1%, respec-tively.Staphyloccous showing resistance to vancomycin and linezolid.CoNS showed resistance to teicoplanin at 2.2%.Resistance rates of Enterococcus spp.to vancomycin, linezolid and teicoplanin were less than 3.8%.The resistance rate of Streptococcus pheumoniae to penicillin was 4.9%.Conclusion The bacterial infection of patients age more than 65 years was mainly caused by gram-negative bacterials and the phenomenon of muti-drug resistance was serious.It was indis-pensable to enhance resistance surveillance and control the development and dissemination of drug resistance bacterials.