CAJ | 학술논문

目的：了解某三甲综合医院多重耐药菌株的科室分布及耐药性分析，以采取针对性的预防、控制和治疗措施。方法回顾性分析该院2014年1～12月检出的1816株多重耐药菌数据。结果1816株多重耐药菌中以产超广谱β‐内酰胺酶（ESBLs）的大肠埃希菌居首位（665株，36．62％），然后依次为耐甲氧西林金黄色葡萄球菌（387株，21．31％）、耐碳青霉烯类抗菌药物的鲍曼不动杆菌（295株，16．22％）、多重耐药／泛耐药铜绿假单胞菌（195株，10．74％）、耐碳青霉烯类抗菌药物的肠杆菌科细菌（144株，7．92％）、产 ESBLs 的肺炎克雷伯菌（130株，7．16％）。分离到的多重耐药菌株主要集中在泌尿外科（384株，21．14％）、烧伤科（325株，17．90％）、重症监护室（IC U ，266株，14．52％）、神经外科（110株，6．04％）。耐甲氧西林金黄色葡萄球菌对万古霉素和利奈唑胺的耐药率为0．0％；产ESBLs大肠埃希菌和肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药率较低，小于2．9％；耐碳青霉烯类抗菌药物的肠杆菌科细菌对阿米卡星、复方磺胺甲噁唑、美洛培南和四环素的耐药率较低（39．6％～60．7％）；耐碳青霉烯类抗菌药物的鲍曼不动杆菌对左旋氧氟沙星、四环素、复方磺胺甲噁唑和头孢哌酮／舒巴坦耐药率较低（48．9％～76．5％）；多重耐药／泛耐药铜绿假单胞菌对阿米卡星、头孢他啶、庆大霉素和环丙沙星耐药率较低（45．3％～66．7％）。结论应加强对高危科室的监控，制定有针对性的预防控制措施，并根据药敏结果进行临床用药。
목적：료해모삼갑종합의원다중내약균주적과실분포급내약성분석，이채취침대성적예방、공제화치료조시。방법회고성분석해원2014년1～12월검출적1816주다중내약균수거。결과1816주다중내약균중이산초엄보β‐내선알매（ESBLs）적대장애희균거수위（665주，36．62％），연후의차위내갑양서림금황색포도구균（387주，21．31％）、내탄청매희류항균약물적포만불동간균（295주，16．22％）、다중내약／범내약동록가단포균（195주，10．74％）、내탄청매희류항균약물적장간균과세균（144주，7．92％）、산 ESBLs 적폐염극뢰백균（130주，7．16％）。분리도적다중내약균주주요집중재비뇨외과（384주，21．14％）、소상과（325주，17．90％）、중증감호실（IC U ，266주，14．52％）、신경외과（110주，6．04％）。내갑양서림금황색포도구균대만고매소화리내서알적내약솔위0．0％；산ESBLs대장애희균화폐염극뢰백균대탄청매희류항균약물적내약솔교저，소우2．9％；내탄청매희류항균약물적장간균과세균대아미잡성、복방광알갑오서、미락배남화사배소적내약솔교저（39．6％～60．7％）；내탄청매희류항균약물적포만불동간균대좌선양불사성、사배소、복방광알갑오서화두포고동／서파탄내약솔교저（48．9％～76．5％）；다중내약／범내약동록가단포균대아미잡성、두포타정、경대매소화배병사성내약솔교저（45．3％～66．7％）。결론응가강대고위과실적감공，제정유침대성적예방공제조시，병근거약민결과진행림상용약。
Objective To investigate the characteristics of department distribution and antibacterial resistance of multidrug‐re‐sistant(MDR) pathogens in hospital ,and take specific measures for the prevention ,treatment and infection cntrol .Methods Data of 1 816 MDR isolates detected in the hospital from January to December in 2014 were analyzed retrospectively .Results Among the 1 816 MDR strains ,extended‐spectrum β lactamases(ESBLs) producing Escherichia coli ranked first(665 strains ,36 .62% ) ,fol‐lowed by methicillin‐resistant Staphylococcus aureus(387 strains ,21 .31% ) ,MDR Acinetobacter baumannii(295 strains ,16 .22% ) , MDR Pseudomonas aeruginosa(195 strains ,10 .74% ) ,carbapenem‐resistant Enterobacteriaceae(144 strains ,7 .92% ) ,ESBLs pro‐ducing Klebsiella pneumoniae(130 strains ,7 .16% ) .MDR strains were mainly distributed in general department of urology surgery (384 strains ,21 .14% ) ,burn unit(325 strains ,17 .90% ) ,intensive care unit(ICU )(266 strains ,14 .52% ) and department neurosur‐gery(110 strains ,6 .04% ) .Vancomycin and linezolid resistance were not found in methicillin‐resistant Staphylococcus aureus ;less than 2 .9% of the ESBLs producing Escherichia coli and Klebsiella pneumonia strains were resistant to carbapenems .The resistance of carbapenem‐resistant Enterobacteriaceae to amikacin ,sulfamethoxazole‐trimethoprim ,meropenem and tetracycline were relatively low (39 .6% -60 .7% ) .The resistance of MDR Acinetobacter baumannii to levofloxacin ,tetracycline ,sulfamethoxazole‐trime‐thoprim and cefoperazone‐sulbactam were relatively low (48 .9% -76 .5% ) .The resistance of MDR Pseudomonas aeruginosa to amikacin ,ceftazidime ,gentamicin and ciprofloxacin were relatively low(45 .3% -66 .7% ) .Conclusion The MDR pathogens should be monitored in high‐risk department ,preventive measures should be taken ,and antibiotics should be used according to the results of drug susceptibility tests .