2007-2009年新疆医科大学第一附属医院急诊重症监护室细菌耐药监测
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摘要
目的：监测新疆医科大学第一附属医院急诊重症监护室2007.1-2009.12月临床分离细菌对抗菌药物的耐药性。方法：收集患者首次非同一部位不同菌株431株,以CLSI推荐的纸片扩散法(Kirby-bauer法)及MIC法测定其抗菌药物敏感性,临床分离出的菌株鉴定采用VITEK TWO全自动微生物分析仪分析,用SPASS5.0软件分析结果。结果：本文共检出431株细菌,其中革兰氏阴性菌68.2%,革兰氏阳性菌31.8%。鲍曼不动杆菌、铜绿假单胞菌、洋葱伯克霍尔德菌等非发酵糖杆菌数目在逐年上升。其中鲍曼不动杆菌最敏感的是头孢哌酮/舒巴坦(平均65.1%),然而对亚胺培南、美罗培南耐药性却很高,耐药率最高达84.2%。2008年铜绿假单胞菌对庆大霉素、左氧氟沙星、环丙沙星、头孢哌酮-舒巴坦的敏感性较高(75.1%-91.6%),但是在2009年的敏感性仅为(15.5%-23.2%),对碳青酶烯类抗生素敏感性保持在37.5%-75%。临床分离的大肠埃希菌、肺炎克雷伯的ESBLs检出率分别为61.9%,74.2%(66.6%-85.7%)。两者对亚胺培南保持高度敏感,分别为90.5%,88.3%,对第三、四代头孢菌素类耐药率均在50%以上。所有葡萄球菌对万古霉素100%敏感。金葡菌对磷霉素、褐霉素、喹奴普叮敏感率均在60%以上。MRSA对复方新诺明、磷霉素敏感率在50%以上,其他抗生素均较耐药。屎肠球菌与粪肠球菌对万古霉素、替考拉宁敏感率最高(90%,100%),共检出1株耐万古霉素屎肠球菌。结论：非发酵糖杆菌数目不断增加,对抗生素的耐药率不断升高。肠杆菌科细菌对碳青霉烯类仍最敏感。本次未检测出耐万古霉素葡萄糖菌属,但检出1株耐万古霉素屎肠球菌。
Objectve:To investigate the antibiotic resistance in clinical bacteriums from Emergency Intensive Care Unit of The First Affliaited Hospital of Xinjiang Medicial University in 2007-2009.Metods:A total of 431 nonduplicate isolates were collected.The sensitivity was tested by Kirby-bauer methods and MIC methods as recommended by CLSI.The strains were identified by VITEK TWO automatic microorganism analyzing system.All the dates were analyzed by SPASS5.0 software.Results:A total of 431 nonduplicate bacteriums were collected,of which 68.3% were gram-negative bacillus and 31.7% were gram-positive coccobacteria.The numbers of Non-fermenting(A.baumanni i,P.aeruginosa, Burkhol deria cepacia) is upgrading year by year.The highest sensitivity of A.baumannii is Cefoperazone/sulbactam(average 65.1%). The percentage of P.aerugin-osa susceptible to Gentamycin, Levofloxacin,Ciprofloxacin and Cefuroxime ranged from 75.1% to 91.6% in 2008,but,in 2009,the susceptible to them only 15.5%-23.2%.The susceptible to Imipenem,Meropenem remaining in 37.5%-75%.The prevalence of exten-ded spectrumβ-lactamases(ESBLs) was 61.9% in E.coil and 74.2%(66.6%-85.7%) in K.pneumoiae.Above 50% of the two Non-fermenting isolates were resistant to third or forth Cephalosporins.Vancomycin inhibited all Staphylococcus islates.Fosfomycin, Fuso-mycin,Quinuprisyin tested inhibited more than 60% of S.aureus isolates.Above 50% of MRSA strains were susceptible to Fosfomycin,Trimethoprim/su lfa,MRSA isolates were highly resistant to all other antimicrobial agents.E.faecium and E.faecalis were most susceptible to vancomycin and teicoplanin(90%,100%).One of vancomycin-resistant E.faecium were indentified.Conclsions: The number of Non-fermenting bacteriums is incresing every year.It's drug resistance is stepping up.Carbapenems are still the most active agents againsts Enterobacteriaceae strains.None of Staphylococcus isolates is fou-nd resistant to vancomycin. But, one of E.faecium is found resistant to vancomycin.
Objectve:To investigate the antibiotic resistance in clinical bacteriums from Emergency Intensive Care Unit of The First Affliaited Hospital of Xinjiang Medicial University in 2007-2009.Metods:A total of 431 nonduplicate isolates were collected.The sensitivity was tested by Kirby-bauer methods and MIC methods as recommended by CLSI.The strains were identified by VITEK TWO automatic microorganism analyzing system.All the dates were analyzed by SPASS5.0 software.Results:A total of 431 nonduplicate bacteriums were collected,of which 68.3% were gram-negative bacillus and 31.7% were gram-positive coccobacteria.The numbers of Non-fermenting(A.baumanni i,P.aeruginosa, Burkhol deria cepacia) is upgrading year by year.The highest sensitivity of A.baumannii is Cefoperazone/sulbactam(average 65.1%). The percentage of P.aerugin-osa susceptible to Gentamycin, Levofloxacin,Ciprofloxacin and Cefuroxime ranged from 75.1% to 91.6% in 2008,but,in 2009,the susceptible to them only 15.5%-23.2%.The susceptible to Imipenem,Meropenem remaining in 37.5%-75%.The prevalence of exten-ded spectrumβ-lactamases(ESBLs) was 61.9% in E.coil and 74.2%(66.6%-85.7%) in K.pneumoiae.Above 50% of the two Non-fermenting isolates were resistant to third or forth Cephalosporins.Vancomycin inhibited all Staphylococcus islates.Fosfomycin, Fuso-mycin,Quinuprisyin tested inhibited more than 60% of S.aureus isolates.Above 50% of MRSA strains were susceptible to Fosfomycin,Trimethoprim/su lfa,MRSA isolates were highly resistant to all other antimicrobial agents.E.faecium and E.faecalis were most susceptible to vancomycin and teicoplanin(90%,100%).One of vancomycin-resistant E.faecium were indentified.Conclsions: The number of Non-fermenting bacteriums is incresing every year.It's drug resistance is stepping up.Carbapenems are still the most active agents againsts Enterobacteriaceae strains.None of Staphylococcus isolates is fou-nd resistant to vancomycin. But, one of E.faecium is found resistant to vancomycin.
引文
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[3]罗彦丽.综合ICU病房10年间病菌构成及耐药性变迁分析[J].中国现代医药杂志,2009,11(1)：85-88.
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