摘要
目的调查不同地区部队医院患者血液、尿液等标本中的细菌分布及耐药情况,为合理使用抗菌药物提供实验室依据。方法收集12家部队医院2006年1-12月临床分离的1099株不重复细菌,采用琼脂稀释法测定抗菌药物对细菌的最低抑菌浓度(MIC),计算MIC50、MIC90,并按美国临床实验室标准化协会(CLSI)2007年标准判断敏感率(S%)、中介率(I%)、耐药率(R%),利用WHONET5.4软件进行分析。纸片法检测超广谱β-内酰胺酶(ESBLs),3-氨基苯酚硼酸(APB)纸片增强法检测AmpC酶。结果共获得革兰阳性菌436株(39.7%),革兰阴性菌663株(60.3%)。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRSCN)检出率分别为62%和92%,未发现万古霉素耐药的肠球菌和葡萄球菌。大肠埃希菌(E.coli)、肺炎克雷伯菌产ES-BLs的比率分别为51.1%和45.1%,二者产AmpC酶的比率分别为11.3%和16.2%。血液中E.coli和肺炎克雷伯菌对头孢他啶、阿米卡星、头孢噻肟、头孢西丁和左氧氟沙星的耐药率普遍低于尿液中的相应细菌,而血液中铜绿假单胞菌和不动杆菌对美罗培南、头孢他啶、多黏菌素、米诺环素的耐药率均显著高于尿液中的相应细菌。结论MRSA、MRSCN以及产ESBLs、AmpC酶的耐药细菌在部队医院的发生率较高;自血液和尿液分离的细菌对抗菌药物的耐药性差异较大。
Objective To survey the bacterial species and drug resistance of bacteria isolated from blood, urine and other samples in 12 military hospitals located at different areas in China. Methods A total of 1099 non-repetitive bacterial isolates were collected from 12 military hospitals and sent to the General Hospital of PLA for re-identification and drug susceptibility test. The minimal inhibitory concentrations （MICs） of antimicrobial agents were determined by agar dilution method. The results were evaluated according to the standards of CLSI （2007） and analyzed by WHONET 5.4 software. ESBLs, AmpC β-lactamases were detected using the confirmatory test and APB discs method, respectively. Results Gram positive cocci and gram negative bacilli constituted 39.7% and 60.3% of 1099 clinical isolates respectively. Methicillin-resistant Staphylococcus aureus （MRSA） accounted for 62%, and methicillin-resistant coagulase negative Staphylococcus （MRSCN） accounted for 92%. ESBLs-producing and AmpC-producing strains of Escherichia coli accounted for 51.1% and 11.3%, respectively, and of Klebsiella pneumoniae accounted for 45.1% and 16.2%, respectively. As to caftazidime, amikacin, cefotaxime, cefoxitin and levofloxacin, the resistance rate in Escherichia coli （E. coli） and Klebsiella pneumoniae isolated from blood was lower than that isolated from urine. However, as to meropenem, ceftazidime, polymyxin and minocyclin, the resistance rate in Pseudomonas aeruginosa and Acinetobacter spp isolated from blood was higher than that isolated from urine. Conclusion MRSA, MRSCN, and producers of ESBLs and AmpC β-lactamases are common in military hospitals. Resistance pattern of bacteria from blood differs from that of bacteria from urine. It is necessary for military hospitals to take the bacterial distribution and resistance levels to antimicrobial agents under surveillance in order to guide the proper use of antibiotics for military doctors, and the results may serve as guidelines in the use of antimicrobial agents i
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2008年第5期620-623,共4页
Medical Journal of Chinese People's Liberation Army
基金
全军医学科研“十一五”计划面上项目资助课题(06MA294)
关键词
医院
军队
细菌
分布
耐药监测
hospital, military
bacteria
distribution
resistance surveillance
