CAJ | 학술논문

目的：探讨临床不同来源标本分离的同种细菌对抗菌药物的敏感性有无差异，以便指导临床合理运用抗菌药物。方法对本院各科室2009～2013年送检的痰液、血液、脓液及尿液标本分离的细菌采用全自动微生物鉴定药敏仪检测，并比较4种标本来源的金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌对抗菌药物的耐药性差异。结果4种标本分离的大肠埃希菌和肺炎克雷伯菌对亚胺培南、厄他培南、哌拉西林／他唑巴坦及阿米卡星的耐药率均低，分离的金黄色葡萄球菌均对万古霉素、利奈唑胺、呋喃妥因、喹奴普丁／达福普丁的耐药率低。分离自痰液的大肠埃希菌超广谱β‐内酰胺酶（ESBLs）阳性率为71．5％，耐甲氧西林金黄色葡萄球菌（MRSA）检出率为79．9％，高于其他3种标本（P＜0．05）。尿液中产 ESBLs肺炎克雷伯菌检出率为44．4％，高于其他3种标本，差异有统计学意义（P＜0．05）。结论不同标本分离的同种细菌对多种抗菌药物耐药率不同，建议临床医师在治疗不同标本检出同种细菌引起的感染时，应根据药敏结果合理使用抗菌药物。
목적：탐토림상불동래원표본분리적동충세균대항균약물적민감성유무차이，이편지도림상합리운용항균약물。방법대본원각과실2009～2013년송검적담액、혈액、농액급뇨액표본분리적세균채용전자동미생물감정약민의검측，병비교4충표본래원적금황색포도구균、대장애희균、폐염극뢰백균대항균약물적내약성차이。결과4충표본분리적대장애희균화폐염극뢰백균대아알배남、액타배남、고랍서림／타서파탄급아미잡성적내약솔균저，분리적금황색포도구균균대만고매소、리내서알、부남타인、규노보정／체복보정적내약솔저。분리자담액적대장애희균초엄보β‐내선알매（ESBLs）양성솔위71．5％，내갑양서림금황색포도구균（MRSA）검출솔위79．9％，고우기타3충표본（P＜0．05）。뇨액중산 ESBLs폐염극뢰백균검출솔위44．4％，고우기타3충표본，차이유통계학의의（P＜0．05）。결론불동표본분리적동충세균대다충항균약물내약솔불동，건의림상의사재치료불동표본검출동충세균인기적감염시，응근거약민결과합리사용항균약물。
Objective To explore the differences in antimicrobial resistance of bacteria isolated from different samples ,and to guide antibiotic chemotherapy in clinic .Methods The sputum ,blood ,pus and urine specimens were collected from 2009 to 2013 in our hospital for bacterial identification and drug sensitivity tests by using automatic system .The drug resistance rate of Staphylo‐coccus aureus ,Escherichia coli ,Klebsiella pneumoniae isolated from different samples were compared .Results All isolates of E .co‐li ,Klebsiella pneumoniae were sensitive to imipenem ,ertapenem ,piperacillin/tazobactam and amikacin .All isolates of S .aureus were sensitive to vancomycin ,linezolid ,nitrofurantoin ,quinupristin/dalfopristin .The ESBLs positive rate of E .coli(71 .5% )and the MR‐SA detection rate(79 .9% ) of Staphylococcus aureus from sputum samples were significantly higher than that from other samples (P<0 .05) .The ESBLs positive rate(44 .4% ) of Klebsiella pneumoniae isolates from urine was significantly higher than that from other samples(P<0 .05) .Conclusion The same bacteria isolated from different samples have different antimicrobial resistance rates ,so the selection of antibiotics should based on drug sensitivity tests results for the treatment of the same pathogen infection confirmed by bacterial cultures from different samples .