【摘要】：目的調查不同地區(qū)部隊醫(yī)院患者血液、尿液等標本中的細菌分布及耐藥情況,為合理使用抗菌藥物提供實驗室依據。方法收集12家部隊醫(yī)院2006年1-12月臨床分離的1099株不重復細菌,采用瓊脂稀釋法測定抗菌藥物對細菌的最低抑菌濃度(MIC),計算MIC50、MIC90,并按美國臨床實驗室標準化協(xié)會(CLSI)2007年標準判斷敏感率(S%)、中介率(I%)、耐藥率(R%),利用WHONET5.4軟件進行分析。紙片法檢測超廣譜β-內酰胺酶(ESBLs),3-氨基苯酚硼酸(APB)紙片增強法檢測AmpC酶。結果共獲得革蘭陽性菌436株(39.7%),革蘭陰性菌663株(60.3%)。耐甲氧西林金黃色葡萄球菌(MRSA)和耐甲氧西林凝固酶陰性葡萄球菌(MRSCN)檢出率分別為62%和92%,未發(fā)現(xiàn)萬古霉素耐藥的腸球菌和葡萄球菌。大腸埃希菌(E.coli)、肺炎克雷伯菌產ES-BLs的比率分別為51.1%和45.1%,二者產AmpC酶的比率分別為11.3%和16.2%。血液中E.coli和肺炎克雷伯菌對頭孢他啶、阿米卡星、頭孢噻肟、頭孢西丁和左氧氟沙星的耐藥率普遍低于尿液中的相應細菌,而血液中銅綠假單胞菌和不動桿菌對美羅培南、頭孢他啶、多黏菌素、米諾環(huán)素的耐藥率均顯著高于尿液中的相應細菌。結論MRSA、MRSCN以及產ESBLs、AmpC酶的耐藥細菌在部隊醫(yī)院的發(fā)生率較高;自血液和尿液分離的細菌對抗菌藥物的耐藥性差異較大。
[Abstract]:Objective to investigate the distribution and drug resistance of bacteria in blood and urine of patients in different military hospitals in order to provide laboratory basis for rational use of antimicrobial agents. Methods 1099 clinical isolates from 12 military hospitals from January to December 2006 were collected. Agar dilution method was used to determine the minimum inhibitory concentration (MIC),) of antimicrobial agents against bacteria. MIC50,MIC90, was calculated according to the 2007 (CLSI) standard of American Association of Clinical Laboratory Standardization (Agar). The sensitivity rate (S%), intermediary rate (I%) and drug resistance rate (R%) were determined by WHONET5.4 software. Extended-spectrum 尾 -lactamase (ESBLs) and 3-aminophenol borate (APB) were detected by disk method. AmpC enzyme was detected by (APB) disk enhancement method. Results 436 strains of Gram-positive bacteria (39.7%) and 663 strains of Gram-negative bacteria (60.3%) were obtained. The detectable rates of (MRSCN) in methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococcus were 62% and 92% respectively. Vancomycin resistant Enterococcus and Staphylococcus were not found. The rates of ES-BLs production by Escherichia coli (E.coli) and Klebsiella pneumoniae were 51.1% and 45.1%, respectively. The ratios of AmpC producing enzymes were 11.3% and 16.2%, respectively. The drug resistance rates of E.coli and Klebsiella pneumoniae to ceftazidime, amikacin, cefotaxime, cefoxitin and levofloxacin in blood were generally lower than those in urine, while Pseudomonas aeruginosa and Acinetobacter spp were resistant to meropenem. The drug resistance rates of ceftazidime, polymyxin and minocycline were significantly higher than those of the corresponding bacteria in urine. Conclusion the incidence of MRSA,MRSCN and ESBLs,AmpC enzyme resistant bacteria is higher in military hospitals, and the drug resistance of bacteria isolated from blood and urine is different.
【作者單位】：
【基金】：全軍醫(yī)學科研“十一五”計劃面上項目資助課題(06MA294)
【分類號】：R82

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