本文關鍵詞： 老年患者 細菌耐藥性監(jiān)測 藥物敏感性試驗 多重耐藥菌 廣泛耐藥菌　出處：《中國感染與化療雜志》2016年03期 　論文類型：期刊論文

【摘要】：目的了解國內(nèi)不同地區(qū)17所醫(yī)院2005—2014年老年患者臨床分離菌的分布特點及其對抗菌藥物的耐藥性。方法按統(tǒng)一方案,采用紙片擴散法或自動化儀器法進行細菌藥敏試驗,按照CLSI 2014年標準判讀結果。結果共收集老年臨床分離菌159 888株,占整體人群的33.1%。10年間,老年患者分離菌株的檢出率呈上升趨勢:2005年為30.0%,2014年為32.7%。其中革蘭陽性菌36 659株,占22.9%;革蘭陰性菌123 229株,占77.1%。住院患者分離148 376株,占92.8%。痰液等呼吸道分泌物是細菌的主要分離源,共88 201株,占55.2%。金黃色葡萄球菌(金葡菌)和凝固酶陰性葡萄球菌中MRSA和MRCNS株的平均檢出率分別為67.1%和75.9%。甲氧西林耐藥株對β內(nèi)酰胺類抗生素和其他測試藥物的耐藥率均高于甲氧西林敏感株(MSSA和MSCNS)。葡萄球菌屬中均未發(fā)現(xiàn)對萬古霉素、替考拉寧和利奈唑胺耐藥株。屎腸球菌除對利奈唑胺及氯霉素的耐藥率低于糞腸球菌外,對其余抗菌藥物耐藥率均高于糞腸球菌,屎腸球菌和糞腸球菌對萬古霉素的耐藥率(4.6%,0.4%)高于全國水平(3.2%,0.3%);根據(jù)表型推測多數(shù)為Van A型或Van B型。肺炎鏈球菌非腦膜炎株青霉素敏感株(PSSP)比例(78.2%)低于2014年全國成人組(95.0%)。大腸埃希菌、克雷伯菌屬(肺炎克雷伯菌和產(chǎn)酸克雷伯菌)和奇異變形桿菌中產(chǎn)ESBL株分別占67.5%、40.4%和34.3%。碳青霉烯類抗生素依然對腸桿菌科細菌保持良好的抗菌活性,耐藥率大多10%,其次為阿米卡星、酶抑制劑復合制劑。銅綠假單胞菌對亞胺培南和美羅培南的耐藥率分別為35.9%和33.0%,鮑曼不動桿菌對兩藥的耐藥率均55.0%。廣泛耐藥革蘭陰性桿菌中銅綠假單胞菌的分離率(4.0%~1.8%)高于同年全國整體分離率(2.1%~1.6%);鮑曼不動桿菌廣泛耐藥株從2010年起分離率呈現(xiàn)逐年下降趨勢(19.2%~15.5%),低于同年的全國水平(21.4%~19.7%);腸桿菌科細菌廣泛耐藥株從2008年分離到,分離率(0.1%~1.0%)也低于同年全國水平(0.3%~3.2%)。結論老年患者臨床分離菌分布情況與耐藥性特點不同于全國平均水平。住院患者比例、呼吸道標本比例、不發(fā)酵糖革蘭陰性桿菌比例均高于全國水平�？裂蹙澳c道致病菌的分離率及耐藥率低于全國水平。MRSA、萬古霉素耐藥腸球菌、產(chǎn)ESBL菌及銅綠假單胞菌中廣泛耐藥菌分離率及耐藥率高于全國水平。經(jīng)驗用藥應參考老年人群耐藥監(jiān)測數(shù)據(jù),根據(jù)藥敏試驗結果合理選用抗菌藥物。
[Abstract]:Objective to investigate the distribution characteristics of clinical isolates of geriatric patients in 17 hospitals in different regions of China from 2005 to 2014 and their resistance to antimicrobial agents. Methods according to the unified scheme, bacterial susceptibility tests were carried out by disk diffusion method or automatic instrument method. Results according to the results of CLSI interpretation on 2014, a total of 159,888 strains of clinical isolates were collected, accounting for 33.10.10 years of the whole population, the detection rate of isolated strains of geriatric patients showed an upward trend: 30.0 in 2005 and 32.7in 2014. Among them, 36,659 were Gram-positive bacteria. There were 123,229 gram-negative bacteria, accounting for 77.1%. 148 376 strains were isolated from hospitalized patients, accounting for 92.88.Respiratory secretions such as sputum were the main source of bacteria isolation, with 88,201 strains. The average detection rates of MRSA and MRCNS strains in Staphylococcus aureus and coagulase-negative staphylococcus were 67.1% and 75.9, respectively. The resistance rates of methicillin-resistant strains to 尾 -lactam antibiotics and other test drugs were high. No vancomycin was found in either MSSA or MSCNS.Staphylococci were not found in the genus Staphylococcus. The resistant rates of teicoplanin and linazolamide were lower than those of Enterococcus faecalis, but the resistance rate of Enterococcus faecium to other antibiotics was higher than that of Enterococcus faecalis. The drug resistance rate of Enterococcus faecium and Enterococcus faecalis to vancomycin (4.60.40) was higher than that of the whole country (3.2%); according to phenotype, most of them were Van A or Van B. The proportion of penicillin sensitive strains of Streptococcus pneumoniae was 78.2% lower than that of the whole country in 2014. Escherichia coli, Klebsiella (Klebsiella pneumoniae and Klebsiella acidogenes) and Proteus mirabilis accounted for 40.4% and 34.3% of ESBL strains, respectively. Carbapenem antibiotics still maintained good antibacterial activity against Enterobacteriaceae. The drug resistance rate was mostly 10%, followed by amikacin, The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 35.9% and 33.0, respectively. The resistance rate of Acinetobacter baumannii to both was 55.0. The isolation of Pseudomonas aeruginosa from extensively resistant gram-negative bacilli. The isolation rate of Acinetobacter baumannii strains has been decreasing year by year since 2010, which is lower than that of the national level of 21.475% in the same year. The widely resistant strains of Enterobacteriaceae were isolated from 2008, and the strains of Acinetobacter baumannii were isolated from 2008. The isolation rate was also lower than the national level of 0.30.20.Conclusion the distribution of clinical isolated bacteria and the characteristics of drug resistance in elderly patients are different from the national average. The isolation rate and drug resistance rate of caustic bacteria and intestinal pathogenic bacteria were lower than those of national level. MRSA, vancomycin resistant Enterococcus, and vancomycin resistant Enterococcus. The isolation rate and drug resistance rate of ESBL producing bacteria and Pseudomonas aeruginosa were higher than those of the whole country.
【作者單位】： 北京醫(yī)院檢驗科;上海交通大學醫(yī)學院附屬瑞金醫(yī)院;復旦大學附屬華山醫(yī)院;北京協(xié)和醫(yī)院;浙江大學附屬第一醫(yī)院;華中科技大學同濟醫(yī)學院附屬同濟醫(yī)院;廣州醫(yī)科大學附屬第一醫(yī)院;天津醫(yī)科大學總醫(yī)院;安徽醫(yī)科大學第一附屬醫(yī)院;昆明醫(yī)科大學第一附屬醫(yī)院;浙江大學醫(yī)學院附屬邵逸夫醫(yī)院;中國醫(yī)科大學附屬第一醫(yī)院;四川大學華西醫(yī)院;甘肅省人民醫(yī)院;新疆醫(yī)科大學第一附屬醫(yī)院;重慶醫(yī)科大學附屬第一醫(yī)院;內(nèi)蒙古醫(yī)科大學附屬醫(yī)院;
【基金】：人社部留學人員科技活動擇優(yōu)資助項目
【分類號】：R446.5

【相似文獻】

相關期刊論文 前10條

1 左金明;762株臨床分離菌菌株分析[J];臨床檢驗雜志;1995年S1期

2 傅華群,楊春江,余鳳;南昌市外科臨床分離菌耐藥性監(jiān)測[J];江西醫(yī)學院學報;2004年01期

3 張淑芳,張宏江,樸美花,崔炫;1452株臨床分離菌及常見菌藥敏分析[J];中國熱帶醫(yī)學;2005年01期

4 杜先智,黃長武,吳青萍;臨床分離菌藥物敏感性的分析[J];重慶醫(yī)學;2004年04期

5 廖衛(wèi);邢志廣;郭珊;趙潔;郭戰(zhàn)萍;;2009年新鄉(xiāng)地區(qū)臨床分離菌耐藥性監(jiān)測[J];中華醫(yī)院感染學雜志;2011年05期

6 陳衛(wèi)群,陳和明,盧忠心;458株臨床分離菌的種類分布及耐藥性分析[J];實用預防醫(yī)學;2003年06期

7 蘇林光,何遠學,賈杰,莫成錦,馮清貴,吳多榮;�？诘貐^(qū)2000年臨床分離菌耐藥性監(jiān)測[J];中國熱帶醫(yī)學;2002年04期

8 楊玉福,高曉坤,花向紅;臨床分離菌的耐藥性測定與分析[J];中國臨床藥理學與治療學;2003年05期

9 邢志廣;張忠新;楊焦峰;郭珊;廖衛(wèi);陸建福;王志勤;姜鋒;呂慧娟;;新鄉(xiāng)地區(qū)2005年臨床分離菌耐藥性的監(jiān)測[J];現(xiàn)代預防醫(yī)學;2008年05期

10 楊錦端;日本臨床分離菌對伊米配能的敏感性調(diào)查[J];上海醫(yī)藥;1995年03期

相關會議論文 前3條

1 張秀珍;;中國臨床分離菌耐藥現(xiàn)狀及對策[A];抗菌藥物臨床應用論文匯編[C];2005年

2 李煒清;黃雅萍;;我院3673株臨床分離菌與藥敏分析[A];2010年中國藥學大會暨第十屆中國藥師周論文集[C];2010年

3 陳童;周宜蘭;何曉雯;王群興;;2006年我院臨床分離菌的分布及耐藥性分析[A];湖北省暨武漢市微生物學會分析微生物專業(yè)委員會第十屆第五次學術會議論文匯編[C];2008年

相關碩士學位論文 前1條

1 楊春江;外科臨床分離菌耐藥性監(jiān)測及產(chǎn)ESBLs菌耐藥基因型的研究[D];江西醫(yī)學院;2003年

，

本文編號：1548561