CAJ | 학술논문

目的：了解内科和外科病房医院获得性泌尿系感染的主要病原菌分布及菌株对抗菌药物耐药性的差异。方法连续收集秦皇岛市第一医院2012年1月至2014年12月住院患者586份清洁中段尿样本，采用Vitek 2 Compact 全自动微生物鉴定及药敏系统进行菌株的鉴定和药敏试验。应用Excel和SPSS 11．5软件对数据进行分析。结果共检出病原菌661株，其中404株来自内科患者，257株来自外科患者。内科患者大肠埃希菌（44.6％）和肠球菌（23.0％）的检出率高于外科患者（33.1％和16.3％），而铜绿假单胞菌的检出率（4.0％）低于外科患者（24.5％），差异均具有统计学意义（χ2＝8.620、4.309和63.056，P＜0.05或＜0.01）。所有患者分离到的大肠埃希菌和肺炎克雷伯菌对哌拉西林／他唑巴坦、头孢替坦、阿米卡星、亚胺培南和美罗培南的敏感率均较高，为85％～100.0％；大肠埃希菌对氨苄西林／舒巴坦、左氧氟沙星和环丙沙星的敏感性较低，均＜30.0％，且外科患者比内科患者敏感性更低（χ2＝4.987、4.575和5.359，P＜0.05）；分离自内科患者的肺炎克雷伯菌对头孢他啶、庆大霉素和氨曲南的敏感率分别为68.8％、60.6％和69.7％，均高于外科患者（36.0％、32.0％和40.0％），二者差异有统计学意义（χ2＝6.068、4.661和5.115，P＜0.05）。铜绿假单胞菌对哌拉西林／他唑巴坦和阿米卡星的敏感性较高，且分离自外科患者的菌株对这两种药物的敏感性（98.4％和96.8％）高于分离自内科患者的菌株（75.0％和81.3％），差异有统计学意义（χ2＝11.797和5.221，P＜0.05）；分离自外科患者的铜绿假单胞菌对头孢吡肟敏感性亦高（92.1％），但分离自内科患者的菌株对其敏感性却较低（37.5％）（χ2＝24.696，P＜0.01）。屎肠球菌和粪肠球菌对替加环素、万古霉素和利奈唑胺均保持高度敏感，敏感性＞95.0％；粪肠球菌除了对奎奴普丁／达福普汀和四环素高度耐药外，对其他常用抗菌药物的敏感性均大于屎肠球菌，但分离自外科患者的粪肠球菌对莫西沙星的敏感性（33.3％）远低于内科患者（70.8％）（χ2＝4.629，P＜0.05）。结论内、外科患者泌尿系感染的主要病原菌分布不同，对抗菌药物的敏感性存在差异。目的：瞭解內科和外科病房醫院穫得性泌尿繫感染的主要病原菌分佈及菌株對抗菌藥物耐藥性的差異。方法連續收集秦皇島市第一醫院2012年1月至2014年12月住院患者586份清潔中段尿樣本，採用Vitek 2 Compact 全自動微生物鑒定及藥敏繫統進行菌株的鑒定和藥敏試驗。應用Excel和SPSS 11．5軟件對數據進行分析。結果共檢齣病原菌661株，其中404株來自內科患者，257株來自外科患者。內科患者大腸埃希菌（44.6％）和腸毬菌（23.0％）的檢齣率高于外科患者（33.1％和16.3％），而銅綠假單胞菌的檢齣率（4.0％）低于外科患者（24.5％），差異均具有統計學意義（χ2＝8.620、4.309和63.056，P＜0.05或＜0.01）。所有患者分離到的大腸埃希菌和肺炎剋雷伯菌對哌拉西林／他唑巴坦、頭孢替坦、阿米卡星、亞胺培南和美囉培南的敏感率均較高，為85％～100.0％；大腸埃希菌對氨芐西林／舒巴坦、左氧氟沙星和環丙沙星的敏感性較低，均＜30.0％，且外科患者比內科患者敏感性更低（χ2＝4.987、4.575和5.359，P＜0.05）；分離自內科患者的肺炎剋雷伯菌對頭孢他啶、慶大黴素和氨麯南的敏感率分彆為68.8％、60.6％和69.7％，均高于外科患者（36.0％、32.0％和40.0％），二者差異有統計學意義（χ2＝6.068、4.661和5.115，P＜0.05）。銅綠假單胞菌對哌拉西林／他唑巴坦和阿米卡星的敏感性較高，且分離自外科患者的菌株對這兩種藥物的敏感性（98.4％和96.8％）高于分離自內科患者的菌株（75.0％和81.3％），差異有統計學意義（χ2＝11.797和5.221，P＜0.05）；分離自外科患者的銅綠假單胞菌對頭孢吡肟敏感性亦高（92.1％），但分離自內科患者的菌株對其敏感性卻較低（37.5％）（χ2＝24.696，P＜0.01）。屎腸毬菌和糞腸毬菌對替加環素、萬古黴素和利奈唑胺均保持高度敏感，敏感性＞95.0％；糞腸毬菌除瞭對奎奴普丁／達福普汀和四環素高度耐藥外，對其他常用抗菌藥物的敏感性均大于屎腸毬菌，但分離自外科患者的糞腸毬菌對莫西沙星的敏感性（33.3％）遠低于內科患者（70.8％）（χ2＝4.629，P＜0.05）。結論內、外科患者泌尿繫感染的主要病原菌分佈不同，對抗菌藥物的敏感性存在差異。
목적：료해내과화외과병방의원획득성비뇨계감염적주요병원균분포급균주대항균약물내약성적차이。방법련속수집진황도시제일의원2012년1월지2014년12월주원환자586빈청길중단뇨양본，채용Vitek 2 Compact 전자동미생물감정급약민계통진행균주적감정화약민시험。응용Excel화SPSS 11．5연건대수거진행분석。결과공검출병원균661주，기중404주래자내과환자，257주래자외과환자。내과환자대장애희균（44.6％）화장구균（23.0％）적검출솔고우외과환자（33.1％화16.3％），이동록가단포균적검출솔（4.0％）저우외과환자（24.5％），차이균구유통계학의의（χ2＝8.620、4.309화63.056，P＜0.05혹＜0.01）。소유환자분리도적대장애희균화폐염극뢰백균대고랍서림／타서파탄、두포체탄、아미잡성、아알배남화미라배남적민감솔균교고，위85％～100.0％；대장애희균대안변서림／서파탄、좌양불사성화배병사성적민감성교저，균＜30.0％，차외과환자비내과환자민감성경저（χ2＝4.987、4.575화5.359，P＜0.05）；분리자내과환자적폐염극뢰백균대두포타정、경대매소화안곡남적민감솔분별위68.8％、60.6％화69.7％，균고우외과환자（36.0％、32.0％화40.0％），이자차이유통계학의의（χ2＝6.068、4.661화5.115，P＜0.05）。동록가단포균대고랍서림／타서파탄화아미잡성적민감성교고，차분리자외과환자적균주대저량충약물적민감성（98.4％화96.8％）고우분리자내과환자적균주（75.0％화81.3％），차이유통계학의의（χ2＝11.797화5.221，P＜0.05）；분리자외과환자적동록가단포균대두포필우민감성역고（92.1％），단분리자내과환자적균주대기민감성각교저（37.5％）（χ2＝24.696，P＜0.01）。시장구균화분장구균대체가배소、만고매소화리내서알균보지고도민감，민감성＞95.0％；분장구균제료대규노보정／체복보정화사배소고도내약외，대기타상용항균약물적민감성균대우시장구균，단분리자외과환자적분장구균대막서사성적민감성（33.3％）원저우내과환자（70.8％）（χ2＝4.629，P＜0.05）。결론내、외과환자비뇨계감염적주요병원균분포불동，대항균약물적민감성존재차이。
Objective To investigate the distribution and drug resistance of pathogens for hospital-acquired urinary tract infections between patients in internal medicine wards and in surgical wards .Methods A total of 586 midstream urine samples were collected from patients in the First Municipal Hospital of Qinhuangdao during January 2012 and December 2014.Vitek 2 Compact system was applied in bacteria identification and drug sensitivity tests .Excel and SPSS 11.5 software were applied for data analysis . Results A total of 661 strains were isolated , in which 404 strains were from internal medicine wards and 257 strains were from surgical wards .Escherichia coli (44.6%vs.33.1%) and Enterococcus (23.0%vs. 16.3%) infections were more common in the internal medicine wards (χ2 =8.620 and 4.309, P<0.05), while the occurrence of Pseudomonas aeruginosa infection (4.0%vs.24.5%) was higher in surgical wards (χ2 =63.056, P <0.01).Escherichia coli and Klebsiella pneumonia strains were highly sensitive to piperacillin/tazobactam, cefptetan, amikacin, imipenem, and meropenem, and the sensitivity rates were from 85% to 100.0%.The sensitivity rates of Escherichia coli to ampicillin/sulbactam, levofloxacin and ciprofloxacin were <30%, and strains from surgical wards had lower sensitivity rates to these drug than those isolated from internal medicine wards (χ2 =4.987, 4.575 and 5.359, P<0.05).The sensitivity rates of Klebsiella pneumonia isolated from internal medicine wards to ceftazidime , gentamicin and aztreonam were 68.8%, 60.6% and 69.7%, which were higher than those isolated from surgical wards (36.0%, 32.0%, and 40.0%), and the differences were of statistical significance (χ2 =6.068,4.661 and 5.115, P<0.05).Pseudomonas aeruginosa strains were highly sensitive to piperacillin/tazobactam and amikacin, and the susceptibilities of strains isolated from surgical wards (98.4%and 96.8%) were higher than those isolated from internal medicine wards (75.0% and 81.3%) (χ2 =11.797 and 5.221, P <0.05). Pseudomonas aeruginosa strains isolated from surgical wards were also highly sensitive to cefepime (92.1%), but the sensitive rate of strains from internal medicine wards was only 37.5%, and the difference was of statistical significance (χ2 =24.696, P<0.01).Enterococcus faecium and Enterococcus faecalis were sensitive to tigecycline , vancomycin and linezolid with the sensitivity rates over 95%.Except quinupristin/dalfopristin and tetracycline , the sensitivities of Enterococcus faecalis to other antibiotics were higher than Enterococcus faecium.Susceptibility of Enterococcus faecium from surgical wards (33.3%) to moxifloxacin was lower than those from internal medicine wards (70.8%), and the difference was of statistical significance (χ2 =4.629, P <0.05).Conclusion There are differences in distribution and antimicrobial susceptibility of pathogens isolated from internal medicine wards and from surgical wards .