CAJ | 학술논문

目的：了解下呼吸道感染病原菌分布情况及其对常用抗菌药物的耐药性。方法回顾分析华中科技大学同济医学院附属同济医院2013年重症监护室( ICU)与非ICU患者下呼吸道感染病原菌的分布情况及耐药性,病原菌按照常规手工方法进行鉴定,疑难菌株采用VITEK-2-COMPACT鉴定系统。药敏试验采用纸片扩散法进行。结果 ICU患者下呼吸道共分离病原菌956株,其中革兰阳性菌231株(24.2％),革兰阴性菌680株(71.1％),真菌45株(4.7％)；非ICU患者共分离病原菌4464株,革兰阳性菌1090株(24.4％),革兰阴性菌3226株(72.3％),真菌148株(3.3％)。ICU与非ICU患者下呼吸道分离的最常见病原菌(前三位)均为金黄色葡萄球菌、鲍曼不动杆菌和铜绿假单胞菌。耐甲氧西林金黄色葡萄球菌(MRSA)的检出率在ICU和非ICU分别为87.0％和74.0％。除了青霉素、红霉素和克林霉素外,对甲氧西林敏感金黄色葡萄球菌(MSSA)对其他常用抗菌药物的敏感率均较高(>80.0％),MRSA除了对万古霉素、替考拉宁和利奈唑胺敏感率高以外,对复方磺胺甲唑和磷霉素的敏感率亦较高(>75.0％)。鲍曼不动杆菌耐药现象严重,对常用抗菌药物的敏感率均低于40.0％。 ICU患者分离的铜绿假单胞菌比非ICU分离株耐药现象严重,对常用抗菌药物的敏感率均低于50.0％。嗜麦芽窄食单胞菌对左氧氟沙星、米诺环素和复方磺胺甲唑的敏感率较高(>80.0％)。大肠埃希菌和肺炎克雷伯菌除了对美罗培南和亚胺培南保持较高的敏感率外,对哌拉西林/他唑巴坦和阿米卡星敏感率也较高(>80.0％)。结论2013年华中科技大学同济医学院附属同济医院下呼吸道感染分离的病原菌以革兰阴性菌为主,最常见的病原菌为金黄色葡萄球菌、鲍曼不动杆菌和铜绿假单胞。 ICU分离株对常用抗菌药物的耐药现象较非ICU分离株显著,临床医师应根据药敏试验结果合理选择抗菌药物。目的：瞭解下呼吸道感染病原菌分佈情況及其對常用抗菌藥物的耐藥性。方法迴顧分析華中科技大學同濟醫學院附屬同濟醫院2013年重癥鑑護室( ICU)與非ICU患者下呼吸道感染病原菌的分佈情況及耐藥性,病原菌按照常規手工方法進行鑒定,疑難菌株採用VITEK-2-COMPACT鑒定繫統。藥敏試驗採用紙片擴散法進行。結果 ICU患者下呼吸道共分離病原菌956株,其中革蘭暘性菌231株(24.2％),革蘭陰性菌680株(71.1％),真菌45株(4.7％)；非ICU患者共分離病原菌4464株,革蘭暘性菌1090株(24.4％),革蘭陰性菌3226株(72.3％),真菌148株(3.3％)。ICU與非ICU患者下呼吸道分離的最常見病原菌(前三位)均為金黃色葡萄毬菌、鮑曼不動桿菌和銅綠假單胞菌。耐甲氧西林金黃色葡萄毬菌(MRSA)的檢齣率在ICU和非ICU分彆為87.0％和74.0％。除瞭青黴素、紅黴素和剋林黴素外,對甲氧西林敏感金黃色葡萄毬菌(MSSA)對其他常用抗菌藥物的敏感率均較高(>80.0％),MRSA除瞭對萬古黴素、替攷拉寧和利奈唑胺敏感率高以外,對複方磺胺甲唑和燐黴素的敏感率亦較高(>75.0％)。鮑曼不動桿菌耐藥現象嚴重,對常用抗菌藥物的敏感率均低于40.0％。 ICU患者分離的銅綠假單胞菌比非ICU分離株耐藥現象嚴重,對常用抗菌藥物的敏感率均低于50.0％。嗜麥芽窄食單胞菌對左氧氟沙星、米諾環素和複方磺胺甲唑的敏感率較高(>80.0％)。大腸埃希菌和肺炎剋雷伯菌除瞭對美囉培南和亞胺培南保持較高的敏感率外,對哌拉西林/他唑巴坦和阿米卡星敏感率也較高(>80.0％)。結論2013年華中科技大學同濟醫學院附屬同濟醫院下呼吸道感染分離的病原菌以革蘭陰性菌為主,最常見的病原菌為金黃色葡萄毬菌、鮑曼不動桿菌和銅綠假單胞。 ICU分離株對常用抗菌藥物的耐藥現象較非ICU分離株顯著,臨床醫師應根據藥敏試驗結果閤理選擇抗菌藥物。
목적：료해하호흡도감염병원균분포정황급기대상용항균약물적내약성。방법회고분석화중과기대학동제의학원부속동제의원2013년중증감호실( ICU)여비ICU환자하호흡도감염병원균적분포정황급내약성,병원균안조상규수공방법진행감정,의난균주채용VITEK-2-COMPACT감정계통。약민시험채용지편확산법진행。결과 ICU환자하호흡도공분리병원균956주,기중혁란양성균231주(24.2％),혁란음성균680주(71.1％),진균45주(4.7％)；비ICU환자공분리병원균4464주,혁란양성균1090주(24.4％),혁란음성균3226주(72.3％),진균148주(3.3％)。ICU여비ICU환자하호흡도분리적최상견병원균(전삼위)균위금황색포도구균、포만불동간균화동록가단포균。내갑양서림금황색포도구균(MRSA)적검출솔재ICU화비ICU분별위87.0％화74.0％。제료청매소、홍매소화극림매소외,대갑양서림민감금황색포도구균(MSSA)대기타상용항균약물적민감솔균교고(>80.0％),MRSA제료대만고매소、체고랍저화리내서알민감솔고이외,대복방광알갑서화린매소적민감솔역교고(>75.0％)。포만불동간균내약현상엄중,대상용항균약물적민감솔균저우40.0％。 ICU환자분리적동록가단포균비비ICU분리주내약현상엄중,대상용항균약물적민감솔균저우50.0％。기맥아착식단포균대좌양불사성、미낙배소화복방광알갑서적민감솔교고(>80.0％)。대장애희균화폐염극뢰백균제료대미라배남화아알배남보지교고적민감솔외,대고랍서림/타서파탄화아미잡성민감솔야교고(>80.0％)。결론2013년화중과기대학동제의학원부속동제의원하호흡도감염분리적병원균이혁란음성균위주,최상견적병원균위금황색포도구균、포만불동간균화동록가단포。 ICU분리주대상용항균약물적내약현상교비ICU분리주현저,림상의사응근거약민시험결과합리선택항균약물。
Objective To investigate distribution and drug resistance of pathogenic bacteria in lower respitatory tract infection. Methods Distribution and drug resistance of pathogenic bacteria in lower respitatory tract infection of patients in ICU and non-ICU of our hospital during 2013 were retrospectivly analyzed. The pathogens were identified by manual methods routinely and those difficult to be identified were analyzed by using the VITEK-2-COMPACT instrument. Antimicrobial susceptibility of these isolates were tested by Kirby-Bauey methods routinely. Results In total, 956 strains were isolated from lower respitatory tract infection of patients in ICU, including 231 strains of gram-positive cocci (24. 2%), 680 strains of gram-negative bacteria (71. 1%), 45 strains of fungi (4. 7%). In patients of non-ICU, 4 464 strains were isolated, including 1 090 strains of gram-positive cocci (24. 4%), 3 226 strains of gram-negative bacteria (72. 3%), and 148 strains of fungi (3. 3%). Staphylococcus aureus, acinetobacter baumannii and pseudomonas aeruginosa were the most frequent isolates in patients of ICU and non-ICU. The overall prevalence of methicillin resistant staphylococcus aureus (MRSA) in staphylococcus aureus was 87. 0%in ICU and 74. 0% in non-ICU. MSSA was sensitive to the most antibiotics ( more than 80. 0% of the strains were sensitive to common antibiotics) except penicillin, erythromycin and clindamycin. MRSA was sensitive to trimethoprim-sulfamethoxazole and fosfomycin (more than 75. 0% of the strains were sensitive to the antibiotics) except for vancomycin, teicoplanin and linezolid. Acinetobacter baumannii was more resistant to the antibiotics (less than 40. 0% of the strains were susceptible to the antibiotics). Pseudomonas aeruginosa from ICU was more resistant to the antibiotics ( less than 50. 0% of the strains were sensitive to the antibiotics) than that from non-ICU. Stenotrophomonas maltophilia was sensitive to trimethoprim-sulfamethoxazole, levofloxacin and minocycline (more than 80. 0% of the strains were sensitive to the antibiotics). Escherichia coli and Klebsiella pneumoniae were sensitive to Piperacillin-tazobactam and Amikacin except for meropenem and imipenem ( more than 80. 0% of the strains were sensitive to the antibiotics) . Conclusion Gram-negative bacteria was the most frequent isolate in lower respitatory tract infection of our hospital during 2013. Staphylococcus aureus, acinetobacter baumannii and pseudomonas aeruginosa were the most frequent isolates in ICU and non-ICU. Resistance to the antibiotics was more common in ICU than in non-ICU. Antibiotics should be prescribed according to bacterial resistance results reasonably in order to prevent the spread of drug-resistant strains.