解放军医学院学报
解放軍醫學院學報
해방군의학원학보
Academic Journal of Chinese Pla Medical School
2015年
11期
1099-1102,1105
,共5页
丁毅伟%郝秀红%李艳君%钱扬会%赵强元
丁毅偉%郝秀紅%李豔君%錢颺會%趙彊元
정의위%학수홍%리염군%전양회%조강원
细菌耐药性监测%无菌体液%细菌分布%抗菌药物
細菌耐藥性鑑測%無菌體液%細菌分佈%抗菌藥物
세균내약성감측%무균체액%세균분포%항균약물
bacterial resistance surveillance%sterile bodyfluid%bacterial distribution%antibiotic
目的：了解2012-2014年我院从临床分离自脑脊液和其他无菌体液(胸腔积液、腹水、胆汁等)细菌的临床分布及耐药性，为临床合理选用抗菌药物提供依据。方法对我院2012-2014年脑脊液和其他无菌体液(胸腔积液、腹水、胆汁等)分离出的第一株细菌进行检出率、分布特点及药敏结果的回顾性分析。结果从2012-2014年分离无菌体液标本分别为120株、141株、160株。革兰阴性杆菌分离率＞70%；革兰阳性球菌分离率＞35%，革兰阳性真菌分离率＞8%。前列腺液、胆汁、脑脊液分离率逐年升高，均＞30%。前列腺液标本主要分离出阳性球菌，以表皮葡萄球菌为主；胆汁、胸腔积液主要分离出阴性杆菌，以大肠埃希菌为主。表皮葡萄球菌和溶血葡萄球菌对克林霉素、红霉素的耐药率均＞60%，青霉素耐药率均＞85%，3年未发现对呋喃妥因、奎奴普汀-达福普汀、替加环素、万古霉素、替考拉宁的耐药株。大肠埃希菌对喹诺酮类耐药性＞60%，但对哌拉西林/他唑巴坦、头孢替坦有很好的敏感性，对亚胺培南、阿米卡星、呋喃妥因、美罗培南无耐药性。肺炎克雷伯菌对美洛培南、呋喃妥因、头孢替坦、亚胺培南的敏感率则不如大肠埃希菌，均出现耐药现象。耐碳氢霉烯酶的肺炎克雷伯菌(CRE)3年耐药率逐渐升高，甚至超过15%。对铜绿假单胞菌敏感性较高的药物是阿米卡星，但氨苄西林/舒巴坦、头孢替坦、头孢曲松、头孢唑林、头孢呋辛钠、复方新诺明、呋喃妥因、头孢呋辛酯耐药严重，平均耐药率都在90%以上。结论无菌体液的主要病原菌耐药菌株有上升趋势，出现耐碳青霉烯酶的肺炎克雷伯菌，临床应根据耐药性监测数据进行合理的抗菌药物治疗，减少耐药菌株的产生。
目的：瞭解2012-2014年我院從臨床分離自腦脊液和其他無菌體液(胸腔積液、腹水、膽汁等)細菌的臨床分佈及耐藥性，為臨床閤理選用抗菌藥物提供依據。方法對我院2012-2014年腦脊液和其他無菌體液(胸腔積液、腹水、膽汁等)分離齣的第一株細菌進行檢齣率、分佈特點及藥敏結果的迴顧性分析。結果從2012-2014年分離無菌體液標本分彆為120株、141株、160株。革蘭陰性桿菌分離率＞70%；革蘭暘性毬菌分離率＞35%，革蘭暘性真菌分離率＞8%。前列腺液、膽汁、腦脊液分離率逐年升高，均＞30%。前列腺液標本主要分離齣暘性毬菌，以錶皮葡萄毬菌為主；膽汁、胸腔積液主要分離齣陰性桿菌，以大腸埃希菌為主。錶皮葡萄毬菌和溶血葡萄毬菌對剋林黴素、紅黴素的耐藥率均＞60%，青黴素耐藥率均＞85%，3年未髮現對呋喃妥因、奎奴普汀-達福普汀、替加環素、萬古黴素、替攷拉寧的耐藥株。大腸埃希菌對喹諾酮類耐藥性＞60%，但對哌拉西林/他唑巴坦、頭孢替坦有很好的敏感性，對亞胺培南、阿米卡星、呋喃妥因、美囉培南無耐藥性。肺炎剋雷伯菌對美洛培南、呋喃妥因、頭孢替坦、亞胺培南的敏感率則不如大腸埃希菌，均齣現耐藥現象。耐碳氫黴烯酶的肺炎剋雷伯菌(CRE)3年耐藥率逐漸升高，甚至超過15%。對銅綠假單胞菌敏感性較高的藥物是阿米卡星，但氨芐西林/舒巴坦、頭孢替坦、頭孢麯鬆、頭孢唑林、頭孢呋辛鈉、複方新諾明、呋喃妥因、頭孢呋辛酯耐藥嚴重，平均耐藥率都在90%以上。結論無菌體液的主要病原菌耐藥菌株有上升趨勢，齣現耐碳青黴烯酶的肺炎剋雷伯菌，臨床應根據耐藥性鑑測數據進行閤理的抗菌藥物治療，減少耐藥菌株的產生。
목적：료해2012-2014년아원종림상분리자뇌척액화기타무균체액(흉강적액、복수、담즙등)세균적림상분포급내약성，위림상합리선용항균약물제공의거。방법대아원2012-2014년뇌척액화기타무균체액(흉강적액、복수、담즙등)분리출적제일주세균진행검출솔、분포특점급약민결과적회고성분석。결과종2012-2014년분리무균체액표본분별위120주、141주、160주。혁란음성간균분리솔＞70%；혁란양성구균분리솔＞35%，혁란양성진균분리솔＞8%。전렬선액、담즙、뇌척액분리솔축년승고，균＞30%。전렬선액표본주요분리출양성구균，이표피포도구균위주；담즙、흉강적액주요분리출음성간균，이대장애희균위주。표피포도구균화용혈포도구균대극림매소、홍매소적내약솔균＞60%，청매소내약솔균＞85%，3년미발현대부남타인、규노보정-체복보정、체가배소、만고매소、체고랍저적내약주。대장애희균대규낙동류내약성＞60%，단대고랍서림/타서파탄、두포체탄유흔호적민감성，대아알배남、아미잡성、부남타인、미라배남무내약성。폐염극뢰백균대미락배남、부남타인、두포체탄、아알배남적민감솔칙불여대장애희균，균출현내약현상。내탄경매희매적폐염극뢰백균(CRE)3년내약솔축점승고，심지초과15%。대동록가단포균민감성교고적약물시아미잡성，단안변서림/서파탄、두포체탄、두포곡송、두포서림、두포부신납、복방신낙명、부남타인、두포부신지내약엄중，평균내약솔도재90%이상。결론무균체액적주요병원균내약균주유상승추세，출현내탄청매희매적폐염극뢰백균，림상응근거내약성감측수거진행합리적항균약물치료，감소내약균주적산생。
Objective To study the clinical distribution and drug resistance isolated from cerebrospinalfluid and other sterile body fluid (pleural effusion, ascites, bile, etc.) in our hospital from 2012 to 2014, and provide guidance for clinicians in the rational use of antibiotic.Methods The isolation rate, distribution and drug resistance of thefirst isolated strains isolated fromcerebrospinalfluid and other sterile bodyfluids (such as pleural effusion, ascites, bile) in our hospital from 2012 to 2014 were retrospectively analyzed. Results From 2012 to 2014, 120 strains, 141 strains, 160 strains of sterile bodyfluid specimens were separated, respectively. The most common specimen was gram-negative bacilli with separation rate of more than 70%, followed by gram-positive bacteria and fungi, with the separation rate of more than 35% and 8%, respectively. Prostate fluid, bile, cerebrospinal fluid's separation rate increased year by year, which were all more than 30%. From prostatefluid specimens, we mainly isolated positive coccus, in which epidermis staphylococcus was the most; From bile and chest water, we mainly isolated negative bacilli, in which E.coli was the most. The resistance rate of epidermis staphylococcus and hemolytic staphylococci to clindamycin and erythromycin were more than 60%; Penicillin's resistance rate was more than 85%; No strains were found to be resistant to Nitrofurantoin, Quinupristin/dalfopristin, Tigecycline, Vancomycin and Teicoplanin in 3 years. The resistance rate of E. coli to quinolone was more than 60%, with good sensitivity to Piperacillin/tazobactam, Cefotetan, while it had no resistance to Imipenem, Amikacin, Nitrofurantoin and Meropenem. The sensitivity of Klebsiella pneumoniae was less than E. coli to Meropenem, Nitrofurantoin, Cefotetan and Imipenem. The resistance rate of Klebsiella pneumoniae (CRE) in Hydrocarbon mildew resistant enzyme increased gradually in three years and reached even more than 15%. Pseudomonasaeruginosa was more sensitive to Amikacin; but it had severe drug-resistant to Ampicillin/sulbactam, Cefotetan, Ceftriaxone, Cefazolin, Cefuroxime sodium, SMZ-TMP, Nitrofurantoin and Cefuroxime Axetil, with the average drug resistance rate of more than 90%.Conclusion The resistant strains of pathogenic bacteria in sterile bodyfluids show a rising trend. Klebsiella pneumoniae is found to be resistant to carbon penicillium enzyme. It is important for clinicians to monitor the changes of pathogenic bacterialflora and their drug resistance tendency promptly, so as to decrease the production of drug-resistant strains.
