CAJ | 학술논문

目的：分析医院常见革兰阴性杆菌的种类、科室分布及耐药状况，为临床合理应用抗生素提供参考。方法对2013年该院各科室患者各类标本中分离出的革兰阴性杆菌进行菌株鉴定及药敏试验。结果检出革兰阴性杆菌6523株，主要采自呼吸道、泌尿道、血液、创面分泌物、胆汁、引流液及脓液。菌株数位列前5位的科室分别是成人重症监护病区（17．8％）、中医科（6．0％）、泌尿外科（5．8％）、烧伤整形科（5．3％）及呼吸内科（3．5％）；最常见种类的依次为大肠埃希菌（31．0％）、铜绿假单胞菌（20．1％）、鲍曼不动杆菌（18．7％）以及肺炎克雷伯菌（15．9％）。大肠埃希菌对喹诺酮类、磺胺类及哌拉西林耐药性较高，对亚胺培南、美罗培南、阿米卡星均较敏感，细菌耐药率均＜5．0％；铜绿假单胞菌对常用的抗生素均有较高的敏感性；鲍曼不动杆菌对大部分抗生素均有较高的耐药率，仅对头孢哌酮／舒巴坦敏感耐药率30．9％，美罗培南、亚胺培南和阿米卡星对肺炎克雷伯菌保持有较强的抗菌活性（耐药率分别为3．8％、2．3％、6．4％）。结论动态监测医院常见革兰阴性细菌分布及耐药性变迁情况，对医院各科正确合理应用抗生素、提高疗效及减少耐药菌的产生具有重要的临床意义。
목적：분석의원상견혁란음성간균적충류、과실분포급내약상황，위림상합리응용항생소제공삼고。방법대2013년해원각과실환자각류표본중분리출적혁란음성간균진행균주감정급약민시험。결과검출혁란음성간균6523주，주요채자호흡도、비뇨도、혈액、창면분비물、담즙、인류액급농액。균주수위렬전5위적과실분별시성인중증감호병구（17．8％）、중의과（6．0％）、비뇨외과（5．8％）、소상정형과（5．3％）급호흡내과（3．5％）；최상견충류적의차위대장애희균（31．0％）、동록가단포균（20．1％）、포만불동간균（18．7％）이급폐염극뢰백균（15．9％）。대장애희균대규낙동류、광알류급고랍서림내약성교고，대아알배남、미라배남、아미잡성균교민감，세균내약솔균＜5．0％；동록가단포균대상용적항생소균유교고적민감성；포만불동간균대대부분항생소균유교고적내약솔，부대두포고동／서파탄민감내약솔30．9％，미라배남、아알배남화아미잡성대폐염극뢰백균보지유교강적항균활성（내약솔분별위3．8％、2．3％、6．4％）。결론동태감측의원상견혁란음성세균분포급내약성변천정황，대의원각과정학합리응용항생소、제고료효급감소내약균적산생구유중요적림상의의。
Objective To analyze the distributions of species and department ,and drug resistance of common gram-negative bacilli in our hospital in 2013 for providing reference for the clinical reasonable application of antibiotics .Methods Gram-negative bacilli was isolated from patients in various departments of our hospital in 2013 .Strains identification and drug sensitivity were performed .Results 6 523 strains of gram-negative bacilli were mainly isolated from respiratory tract ,urinary tract,blood,secretion of wound,bile,drainage fluid and purulence. The top five departments of accrues with most bacterial strains were adult intensive care unit (17.8%),department of traditional Chinese medicine (6.0%),department of urinary surgery (5.8%),department of burn and plastic surgery (5.3%) and department of respiratory internal medicine(3.5%),respectively;the most common pathogens were Escherichia coli (31.0%),Pseudomonas aeruginosa (20.1%),Acinetobacter baumannii(18.7%) and Klebsiella pneumonia(15.9%).The drug resistance of Escherichia coli to quinolones,sulfonamides and piperacillin was high.Escherichia coli were more sensitive to imipenem ,meropenem and amikacin ,and the rates of drug resistance were less than 5.0%. Pseudomonas aeruginosa was more sensitive to the common antibiotics .Acinetobacter baumannii was more resistant to most antibiotics ,and only sensitive to cefoperazone/shubatan(the rates of drug resistance was 30.9%).Meropenem,imipenem and amikacin had strong antibacterial activity against Klebsiella pneumonia ,and the rates of drug resistance were 3.8%,2.3%and 6.4%,respectively.Conclusion Dynamic monitoring of the distribution and drug resistance of common gram-negative bacilli has important significance for the correct and reasonable application of antibiotics ,improvement of curative efficacy and reduction of resistant bacteria .