CAJ | 학술논문

目的：对佛山地区2010～2011年医院感染非发酵菌的临床分布特点及其耐药状况进行监测和分析，为临床合理使用抗菌药物探寻最佳方法。方法各种临床送检标本按常规分离培养，使用法国梅里埃公司Vitek2‐compact全自动微生物分析仪，结合半自动ATB微生物检测仪与K‐B药敏纸片法相结合进行鉴定和药敏试验，并执行美国国家临床实验标准化研究所（CLSI）2009年规定的标准进行药敏试验的折点判断。结果共分离出4809株非发酵革兰阴性杆菌，检出率以铜绿假单胞最高（1458株，30．0％），其次为鲍曼不动杆菌（730株，15．2％）、嗜麦芽窄食单胞菌（412株，8．6％）和洋葱伯克霍尔德菌（346株，7．2％）。药敏显示，各种非发酵菌对临床常用的各类抗生素均出现不同程度的耐药性，以氨苄西林／舒巴坦和、头孢唑啉、头孢呋辛和头孢西丁为甚，其耐药率可高达96．4％、99．6％、99．1％和98．6％；第3、4代头孢类和氨曲南等的耐药率虽比前者为低，但也出现不同程度的耐药，最高达80％；碳青霉烯类和阿米卡星、舒普深、左氧氟沙星等仍是活性较高的抗菌药物。结论非发酵菌已成为医院感染的最主要病原菌，对各类抗生素都显示不同程度的耐药性，且其耐药率多呈上升趋势，临床应充分利用微生物实验室提供的监测数据，选择最佳的用药方案。
목적：대불산지구2010～2011년의원감염비발효균적림상분포특점급기내약상황진행감측화분석，위림상합리사용항균약물탐심최가방법。방법각충림상송검표본안상규분리배양，사용법국매리애공사Vitek2‐compact전자동미생물분석의，결합반자동ATB미생물검측의여K‐B약민지편법상결합진행감정화약민시험，병집행미국국가림상실험표준화연구소（CLSI）2009년규정적표준진행약민시험적절점판단。결과공분리출4809주비발효혁란음성간균，검출솔이동록가단포최고（1458주，30．0％），기차위포만불동간균（730주，15．2％）、기맥아착식단포균（412주，8．6％）화양총백극곽이덕균（346주，7．2％）。약민현시，각충비발효균대림상상용적각류항생소균출현불동정도적내약성，이안변서림／서파탄화、두포서람、두포부신화두포서정위심，기내약솔가고체96．4％、99．6％、99．1％화98．6％；제3、4대두포류화안곡남등적내약솔수비전자위저，단야출현불동정도적내약，최고체80％；탄청매희류화아미잡성、서보심、좌양불사성등잉시활성교고적항균약물。결론비발효균이성위의원감염적최주요병원균，대각류항생소도현시불동정도적내약성，차기내약솔다정상승추세，림상응충분이용미생물실험실제공적감측수거，선택최가적용약방안。
Objective Monitor and analysis the distribution and resistance of non‐fermentative bacteria from 2010 to 2011 in Foshan region ,to find a reasonable method of clinical application .Methods All kinds of clinical sam‐ples were operated according to the conventional cultivation ,Strain identification and drug susceptibility were ana‐lyzed with the French Merieux Vitek2‐compact automated microbial analyzer ,combined with semi‐automatic ATB mi‐crobial analyzer and K‐B test .Fold point judgement of drug sensitive test was employed accordance with American National Standards Institute clinical trials(CLSI)‐2009 standards .Results 4809 strains non‐fermentative gram‐nega‐tive bacteria were isolated .The detection rate of P .aeruginosa was the highest(1 458 ,30 .0% ) ,followed by Acineto‐bacter baumannii(730 ,15 .2% ) ,Stenotrophomonas maltophilia(412 ,8 .6% )and onion fake Single‐cell bacteria(346 , 7 .2% ) .Susceptibility test results showed that all kinds of non‐fermentation strains appeared different levels of resist‐ance to all kinds of antibiotics .The rate of resistance with ampicillin/sulbactam ,cefazolin ,cefuroxime and cefoxitin could be as high as 96 .4% ,99 .6% ,99 .1% and 98 .6% .The rate of resistance with the third and fourth generations cephalosporins and aztreonam was lower than those before ,but strain also appeared varying degrees in drug resist‐ance ,which can reach 80% .Carbapenems and amikacin ,Sulperazon ,levofloxacin ,etc .are still active high Antibiotics . Conclusion The non‐fermentation bacteria came from varying ways ,which Various types of antibiotics have shown varying degrees of drug resistance .Doctor should make full use of microbiology laboratory data to select the most rea‐sonable regimen for treatment .