中国执业药师
中國執業藥師
중국집업약사
CHINA LICENSED PHARMACIST
2015年
9期
27-31,54
,共6页
革兰阴性菌%病原菌%抗菌药物%耐药性分析
革蘭陰性菌%病原菌%抗菌藥物%耐藥性分析
혁란음성균%병원균%항균약물%내약성분석
Gram-negative Bacteria%Pathogenic Bacteria%Antibacterial Agents%Drug Resistance Analysis
目的：了解我院2014年4-12月革兰阴性菌的分离率及耐药性，以促进我院革兰阴性菌感染的预防和治疗，为临床合理使用抗菌药物提供依据。方法：对我院2014年4-12月微生物检验科分离的菌株进行药敏试验，采用迪尔公司生产的DL-96域半自动细菌测定系统及药敏分析仪进行细菌鉴定和药敏试验，统计分析细菌培养及体外药敏试验数据。结果：共分离出731株细菌，革兰阴性菌504株（68.9%），革兰阳性菌227株（31.1%）。检出产超广谱β-内酰胺酶（ESBLs）大肠埃希菌38株（42.2%），ESBLs肺炎克雷伯菌18株（18.0%）。革兰阴性杆菌是临床的主要致病菌，其中肺炎克雷伯菌（100株，19.8%），大肠埃希菌（90株，17.8%），铜绿假单胞菌（31株，6.15%），鲍曼不动杆菌（31株，6.15%），阴沟肠杆菌（28株，5.56%），占革兰阴性菌的前5位，肠杆菌科细菌对阿米卡星、亚胺培南、美罗培南、头孢吡肟、哌拉西林-他唑巴坦、头孢哌酮-舒巴坦、米诺环素的耐药率分别为1.0%～7.1%，0.0%～2.0%，0.0%～2.2%，0.0%～24.4%，2.0%～7.1%，2.0%～7.1%，6.7%～17.9%，对头孢呋辛、头孢唑林、氨苄西林、复方磺胺甲唑（除肺炎克雷伯菌）都表现为极高的耐药，耐药率大于50%，非发酵菌（铜绿假单胞菌，鲍曼不动杆菌）检出相同，其中鲍曼不动杆菌仅对米诺环素、多黏菌素B、美罗培南、头孢哌酮-舒巴坦、阿米卡星高度敏感（敏感率＞80%），对亚胺培南和美罗培南的耐药率分别为22.6%和19.4%，对其余抗菌药物耐药情况严重，铜绿假单胞菌仅对多黏菌素B、诺氟沙星、左氧氟沙星、环丙沙星敏感性较高（敏感率＞80%）,对亚胺培南和美罗培南的耐药率分别为25.8%和22.6%，对其余抗菌药物耐药情况严重。结论：革兰阴性菌是我院感染的主要病原菌，以肠杆菌为主，耐药现象严重，临床医师应加强病原学送检率，参考药敏试验结果合理选择抗菌药物。
目的：瞭解我院2014年4-12月革蘭陰性菌的分離率及耐藥性，以促進我院革蘭陰性菌感染的預防和治療，為臨床閤理使用抗菌藥物提供依據。方法：對我院2014年4-12月微生物檢驗科分離的菌株進行藥敏試驗，採用迪爾公司生產的DL-96域半自動細菌測定繫統及藥敏分析儀進行細菌鑒定和藥敏試驗，統計分析細菌培養及體外藥敏試驗數據。結果：共分離齣731株細菌，革蘭陰性菌504株（68.9%），革蘭暘性菌227株（31.1%）。檢齣產超廣譜β-內酰胺酶（ESBLs）大腸埃希菌38株（42.2%），ESBLs肺炎剋雷伯菌18株（18.0%）。革蘭陰性桿菌是臨床的主要緻病菌，其中肺炎剋雷伯菌（100株，19.8%），大腸埃希菌（90株，17.8%），銅綠假單胞菌（31株，6.15%），鮑曼不動桿菌（31株，6.15%），陰溝腸桿菌（28株，5.56%），佔革蘭陰性菌的前5位，腸桿菌科細菌對阿米卡星、亞胺培南、美囉培南、頭孢吡肟、哌拉西林-他唑巴坦、頭孢哌酮-舒巴坦、米諾環素的耐藥率分彆為1.0%～7.1%，0.0%～2.0%，0.0%～2.2%，0.0%～24.4%，2.0%～7.1%，2.0%～7.1%，6.7%～17.9%，對頭孢呋辛、頭孢唑林、氨芐西林、複方磺胺甲唑（除肺炎剋雷伯菌）都錶現為極高的耐藥，耐藥率大于50%，非髮酵菌（銅綠假單胞菌，鮑曼不動桿菌）檢齣相同，其中鮑曼不動桿菌僅對米諾環素、多黏菌素B、美囉培南、頭孢哌酮-舒巴坦、阿米卡星高度敏感（敏感率＞80%），對亞胺培南和美囉培南的耐藥率分彆為22.6%和19.4%，對其餘抗菌藥物耐藥情況嚴重，銅綠假單胞菌僅對多黏菌素B、諾氟沙星、左氧氟沙星、環丙沙星敏感性較高（敏感率＞80%）,對亞胺培南和美囉培南的耐藥率分彆為25.8%和22.6%，對其餘抗菌藥物耐藥情況嚴重。結論：革蘭陰性菌是我院感染的主要病原菌，以腸桿菌為主，耐藥現象嚴重，臨床醫師應加彊病原學送檢率，參攷藥敏試驗結果閤理選擇抗菌藥物。
목적：료해아원2014년4-12월혁란음성균적분리솔급내약성，이촉진아원혁란음성균감염적예방화치료，위림상합리사용항균약물제공의거。방법：대아원2014년4-12월미생물검험과분리적균주진행약민시험，채용적이공사생산적DL-96역반자동세균측정계통급약민분석의진행세균감정화약민시험，통계분석세균배양급체외약민시험수거。결과：공분리출731주세균，혁란음성균504주（68.9%），혁란양성균227주（31.1%）。검출산초엄보β-내선알매（ESBLs）대장애희균38주（42.2%），ESBLs폐염극뢰백균18주（18.0%）。혁란음성간균시림상적주요치병균，기중폐염극뢰백균（100주，19.8%），대장애희균（90주，17.8%），동록가단포균（31주，6.15%），포만불동간균（31주，6.15%），음구장간균（28주，5.56%），점혁란음성균적전5위，장간균과세균대아미잡성、아알배남、미라배남、두포필우、고랍서림-타서파탄、두포고동-서파탄、미낙배소적내약솔분별위1.0%～7.1%，0.0%～2.0%，0.0%～2.2%，0.0%～24.4%，2.0%～7.1%，2.0%～7.1%，6.7%～17.9%，대두포부신、두포서림、안변서림、복방광알갑서（제폐염극뢰백균）도표현위겁고적내약，내약솔대우50%，비발효균（동록가단포균，포만불동간균）검출상동，기중포만불동간균부대미낙배소、다점균소B、미라배남、두포고동-서파탄、아미잡성고도민감（민감솔＞80%），대아알배남화미라배남적내약솔분별위22.6%화19.4%，대기여항균약물내약정황엄중，동록가단포균부대다점균소B、낙불사성、좌양불사성、배병사성민감성교고（민감솔＞80%）,대아알배남화미라배남적내약솔분별위25.8%화22.6%，대기여항균약물내약정황엄중。결론：혁란음성균시아원감염적주요병원균，이장간균위주，내약현상엄중，림상의사응가강병원학송검솔，삼고약민시험결과합리선택항균약물。
Objective:To understand the isolation rate and drug resistance of Gram-negative bacteria in our hos-pital from April to December 2014 and to promote the prevention and treatment of gram-negative bacterial infec-tions in our hospital , so as to provide the basis for rational use of antimicrobial agents in clinical practice . Meth-ods:Drug sensitivity tests of bacterial strains were conducted which were isolated by microbiological laboratory of our hospital from April to December 2014 . DL-96II semi-automatic bacterial assay system and drug sensitive ana-lyzer produced by Deere Company were used for bacterial identification and the analysis of the bacterial culture and drug sensitivity test data. Results:About 731 bacterial strains were isolated, 504 strains were gram-negative (68.9%) and 227 gram-positive ( 31 . 1%) . About 38 strains ( 42 . 2%) were extended spectrum of beta-lactamases ( ESBLs ) Escherichia coli strains , 18 strains were ESBLs Klebsiella pneumoniae (18.0%). Gram-negative bacilli were the main pathogenic bacteria in clinic, among which the top five bacteria included Klebsiella pneumoniae (100 strains, 19.8%) , Escherichia coli ( 90 strains , 17 . 8%) , Pseudomonas aeruginosa ( 31 strains , 6 . 15%) , Acinetobacter baumannii ( 31 strains , 6 . 15%) and Enterobacter cloacae ( 28 strains , 5 . 56%) . The drug resistance rates of enterobacteriaceae to amikacin , imipenem , meropenem , cefepime , piperacillin tazobactam , cefoperazone sulbactam and minocycline were 1.0%~7.1%, 0.0%~2.0%, 0.0%~2.2%, 0.0%~24.4%, 2.0%~7.1%, 2.0%~7.1%, 6.7%~17.9% respec-tively , and extremely high resistance rates were showed , which was greater than 50%, to cefuroxime , cefazolin , ampicillin and compound sulfamethoxazole ( except Klebsiella pneumoniae ) . Pseudomonas aeruginosa and Acinetobac-ter baumannii as the non fermentative bacteria were detected with the same results . Acinetobacter baumannii was on-ly highly sensitive to minocycline, polymyxin B, meropenem, cefoperazone sulbactam and amikacin (the sensitive rate was greater than 80%), its resistance rates to imipenem and meropenem were 22.6% and 19.4% and very high resistance rates to other antibacterials . Pseudomonas aeruginosa showed high sensitive to polymyxin B , norfloxacin , levofloxacin and ciprofloxacin ( the sensitive rate was greater than 80%) , its resistant rates to imipenem and meropenem were 25 . 8% and 22 . 6% and very high resistance rates to other antibacterials . Conclusion:Gram-nega-tive bacteria are the main pathogenic bacteria for our hospital infections and the drug resistance of enterobacteri-aceae is serious . Clinicians should pay more attention to the submission rate for testing of pathogens and choose suitable antibacterials according to the results of drug sensitivity test .
