尿路感染细菌谱的变迁及药敏分析

目的 了解尿路感染病原菌分布及其对抗菌剂的耐药性.方法 收集2010年全年尿培养进行病原菌鉴定和药敏实验.结果 尿培养病原菌中,革兰阴性菌占67.7%,以大肠埃希菌多见,对亚胺培南、美罗培南、头霉素类、抑制类和呋喃妥因敏感率高;革兰阳性菌占25.1%,以肠球菌多见,屎肠球菌的耐药率明显高于粪肠球菌,未发现对利奈唑胺耐药,1株粪肠球菌对万古霉素中敏,1株屎肠球菌的万古霉素耐药;真菌的检出率较低.结论 亚胺培南对革兰阴性菌的活性高,利奈唑胺对革兰阳性菌活性高,白色念珠菌对常用抗真菌药物敏感性较好.     

泌尿道感染菌群分布及耐药性分析

目的了解泌尿道感染病原菌分布以及耐药性,为合理应用抗菌药物提供依据。方法分析2005年浙江省人民医院分离自尿液的710株病原菌分布及耐药性。结果分离鉴定菌株列前五位的为大肠埃希菌、粪肠球菌、屎肠球菌、白色念珠菌和肺炎克雷伯菌。其中革兰阴性菌385株(54.23%),革兰阳性菌315株(45.77%),药敏试验表明:大肠埃希菌对亚胺培南、呋喃妥因的耐药率为0.0%和9.4%,粪肠球菌对利奈唑烷、万古霉素的耐药率为0.0%和4.9%,屎肠球菌对利奈唑烷、万古霉素的耐药率为1.9%和2.3%,白色念珠菌对5氟胞嘧啶、两性霉素B耐药率均为0.0%,对氟康唑、伊曲康唑的耐药率为28.9%和31.1%。结论泌尿道感染以大肠埃希菌为主,定期系统地监测细菌耐药对临床用药具有重要意义。     

粪肠球菌和屎肠球菌的临床分布及耐药监测研究

目的 研究临床感染患者中粪肠球菌和屎肠球菌的临床分布、对抗菌药物的敏感性以及耐药情况。方法北京积水潭医院2014年1月至2015年12月临床送检的感染标本,分离粪肠球菌和屎肠球菌进行鉴定和药敏分析。结果 分离出粪肠球菌184株,屎肠球菌109株。粪肠球菌药物敏感性从高到低依次为万古霉素、替考拉宁、氨苄西林、呋喃妥因、利奈唑胺、高浓度庆大霉素。屎肠球菌药物敏感性从高到低依次为替考拉宁、利奈唑胺、万古霉素、四环素、高浓度庆大霉素。检测出耐高浓度庆大霉素(HLGR)粪肠球菌75株,分离率为40.76%,HLGR屎肠球菌48株,分离率为44.04%。检测出2株耐万古霉素的粪肠球菌,分离率为1.09%,9株耐万古霉素霉素的屎肠球菌,分离率为8.26%。结论 肠球菌属的总体耐药率较高,且综合评价屎肠球菌的耐药性高于粪肠球菌,但肠球菌属对于万古霉素、利奈唑胺、替考拉宁等仍然保持较高的敏感性,临床上应选用合适的方法对肠球菌属进行耐药性检测,根据药敏结果选择适当的抗菌药物治疗。     

372例肠球菌对16种抗菌药物的药敏试验研究

目的探讨粪肠球菌和屎肠球菌对16种抗菌药物的耐药性。方法十堰市中医院2010年1月至2014年1月检出的372例肠球菌(280例粪肠球菌和92例屎肠球菌),对青霉素、红霉素、氯霉素、万古霉素、利奈唑胺等16种抗菌药物的药敏试验结果进行统计分析。结果粪肠球菌和屎肠球菌耐药率最高的均是红霉素,分别为86.07%和92.39%,差异无统计学意义(P0.05),耐药率最低的均是利奈唑胺,分别为0.36%和1.09%,差异无统计学意义(P0.05)。在青霉素、氨苄西林、他唑巴坦、奈替米星、环丙沙星和呋喃妥因等6种抗菌药物中,粪肠球菌的耐药率明显高于屎肠球菌,差异有统计学意义(P0.05),而在氯霉素和高浓度链霉素中,粪肠球菌的耐药率明显低于屎肠球菌,差异有统计学意义(P0.05)。结论粪肠球菌和屎肠球菌对16种抗菌药物有不同程度的耐药性,且耐药率有差异。     

2007-2012年浙江萧山医院尿路感染患者的肠球菌分布及耐药性分析

目的 调查从尿路感染患者分离的肠球菌的菌种、临床分布及耐药性,为临床合理选用抗生素提供依据。方法 尿培养采用经典型浸片Uricult,ATB-Expression细菌分析系统进行鉴定和药敏试验;所有资料采用Whonet 5.6软件进行回顾性分析。结果 分离肠球菌238株,主要为粪肠球菌122株（51.3%）和屎肠球菌95株（39.9%）;菌株主要来源列前2位的是内科（38.2%）和泌尿外科（21.0%）;耐药率较高的是红霉素（86.5%）、利福平（75.7%）和四环素（66.4%）;较低的是呋喃妥因（19.7%）、万古霉素（9.6%）和利奈唑胺（0.0%）;粪肠球菌对利福平、红霉素、奎奴普丁/达福普汀和四环素的耐药率较高,均76.5%,万古霉素耐药率0.9%;屎肠球菌对氨苄西林等8种药物耐药率75.8%,万古霉素耐药率4.3%。粪肠球菌对所测试抗生素耐药率仅有四环素、奎奴普丁/达福普汀高于屎肠球菌,其余低于屎肠球菌;利福平、万古霉素和利奈唑胺耐药率在二者间差异无统计学意义。2007年与2012年相比,青霉素、氨苄西林等药物耐药率上升,而环丙沙星、四环素等下降。结论 肠球菌是引起尿路感染的重要病原菌,以粪肠球菌和屎肠球菌为主,不同种类肠球菌耐药率差别较大,加强细菌培养和定期分析其耐药性,有助于提高临床治愈率及合理用药水平。     

宁波地区医院肠球菌的临床分布及耐药研究

目的了解医院肠球菌在临床分布状况及利奈唑胺等抗菌药物对肠球菌的抗菌活性,为临床治疗肠球菌感染合理选择抗菌药物提供指导。方法对本院各种标本分离获得的肠球菌用VITEK微生物自动鉴定仪进行种的鉴定和药物敏感性试验。用WHOVET5软件对统计结果进行分析。结果三年共检出706株肠球菌,其中粪肠球菌432株占肠球菌61．2％,屎肠球菌241株占34．1％,鹑鸡肠球菌33株占4．7％。粪肠球菌对呋喃妥因、青霉素、四环素、莫西沙星、左氧氟沙星的耐药率分别为5．8％、22．2％、71．0％、16．7％和23．8％,而屎肠球菌的耐药率除四环素外均高于粪肠球菌。本组试验发现3株耐万古霉素肠球菌,耐药率为0．43％,肠球菌对利奈唑胺的敏感率为100％。结论肠球菌属细菌在医院内感染逐年增加,耐药率在不断上升,泛耐株在不断增多,本组试验检出3株耐万古霉素肠球菌（VRE）。未发现耐利奈唑胺肠球菌,利奈唑胺是目前治疗泛耐株肠球菌特别是治疗耐万古霉素肠球菌感染的最佳选择,但必须合理使用,同时要密切监测肠球菌的耐药趋势,防止耐药菌株的产生。     

2010年中国CHINET肠球菌属细菌耐药性监测

目的了解2010年中国主要地区临床分离肠球菌属细菌对各类抗菌药物的耐药性。方法国内主要地区14所教学医院(12所综合性医院,2所儿童医院)按统一方案、采用统一的材料、方法(K-B法)和判断标准(CLSI 2010年版)进行肠球菌属细菌的耐药性监测。结果共分离到4 046株非重复肠球菌属细菌,最常见菌种为粪肠球菌1 829株(45.2%)、屎肠球菌1 817株(44.9%)、鹑鸡肠球菌78株(1.9%)、鸟肠球菌54株(1.3%)、铅黄肠球菌49株(1.2%)。肠球菌属对利奈唑胺、万古霉素、替考拉宁仍极敏感,耐药率<4%,万古霉素耐药粪肠球菌和屎肠球菌检出率分别为0.6%、3.6%。粪肠球菌对呋喃妥因、磷霉素和氨苄西林耐药率较低,分别为3.2%、5.7%和11.3%,对高浓度庆大霉素耐药率为44.0%;屎肠球菌耐药性明显高于粪肠球菌,对氨苄西林耐药率接近90%,对高浓度庆大霉素耐药率接近70%,对氯霉素耐药率仅为7.3%,儿童屎肠球菌分离株对磷霉素、呋喃妥因耐药率<10%。不同医院分离的肠球菌属细菌对抗菌药物的耐药率有一定差异。结论屎肠球菌的分离率有增加趋势,肠球菌属细菌对利奈唑胺、万古霉素、替考拉宁依然保持极高的敏感性。     

230株肠球菌的临床分布及耐药性分析

目的了解我院肠球菌在临床标本中的分布及其耐药情况,为临床合理治疗肠球菌感染提供依据。方法对我院2011年1月至2013年6月各类临床标本进行分离培养。菌株鉴定采用全自动细菌鉴定仪,药物敏感性试验采用纸片扩散法．数据采用WHONET5．4软件进行分析和统计。结果从各种临床标本中共分离到肠球菌230株,其中粪肠球菌100株,屎肠球菌107株。标本主要来源于尿液（59．13％）、胆汁（17．39％）和血液（10．00％）。从粪肠球菌和屎肠球菌药物敏感试验对比来看．屎肠球菌的耐药性强于粪肠球菌。在受试抗菌药物中．肠球菌对替考拉宁的耐药率最低,其次为利奈唑胺和万古霉素。结论替考拉宁、利奈唑胺和万古霉素是对肠球菌抑制率最高的药物,但临床已检出耐万古霉素和利奈唑胺的肠球菌。由于肠球菌种的差异其耐药性有较大差异．临床应根据药敏试验结果合理选择抗菌药物。     

某医院2009~2013年粪肠球菌和屎肠球菌的耐药性监测

目的 了解2009~2013年该院临床分离粪肠球菌和屎肠球菌对各类抗菌药物的耐药性。方法 临床分离菌采用最低抑菌浓度法进行细菌的药敏试验,结果按临床实验室标准化协会2013年版的标准进行判断。结果 共分离得到非重复粪肠球菌819株,屎肠球菌726株,这两种菌株对利奈唑胺和万古霉素仍很敏感,耐药率均低于1.5%。粪肠球菌和屎肠球菌对万古霉素的耐药率分别为0.1%和1.5%。粪肠球菌对青霉素、氨苄西林和呋喃妥因的耐药率较低,分别为4.3%、1.6%和1.6%;屎肠球菌对青霉素和氨苄西林的耐药率都在87.0%以上,明显高于粪肠球菌。结论 该院的肠球菌感染中以粪肠球菌为主,屎肠球菌感染次之,二者的耐药性差异明显,持续监测其耐药情况有助于指导临床合理用药。     

肠球菌的临床分布特征及对利奈唑胺等新型抗菌药物的耐药性分析

目的:研究肠球菌属的分布特征及对利奈唑胺、奎奴普丁/达福普丁等新型抗菌药物的耐药性,为临床合理用药提供依据。方法:使用VITEK2-compact全自动微生物分析仪进行细菌鉴定。药敏实验采用最小抑菌浓度(MIC)法,运用统计学软件EpiInfor2000、WHONE5.4分析实验数据。结果:在所有170株受检肠球菌中,屎肠球菌、粪肠球菌、其他肠球菌分别占52.9%、41.2%和5.9%。检出肠球菌株数最多的标本是尿液,其余为胆汁和血液等。药敏结果表明,肠球菌属总体耐药水平较高,仅对万古霉素和利奈唑胺极度敏感,屎肠球菌除对氯霉素、四环素、奎奴普丁/达福普丁的耐药率低于粪肠球菌以外,对其他多数抗生素的耐药率均高于粪肠球菌。利奈唑胺对屎肠球菌和粪肠球菌的MIC值大多为1和2μg/L。72%粪肠球菌对奎奴普丁/达福普丁的MIC值大于2μg/L,而80%的屎肠球菌对其的MIC值则小于2 mg/L。结论:临床肠球菌属感染以屎肠球菌、粪肠球菌为主,屎肠球菌对大多数抗生素的耐药率均高于粪肠球菌。利奈唑胺对屎肠球菌和粪肠球菌均显示出了强大的抗菌活性,而奎奴普丁/达福普丁只对屎肠球菌有较好的抗菌活性。临床治疗应根据药敏试验合理应用抗菌药物,或选用利奈唑胺治疗耐万古霉素的肠球菌所引起的感染,同时密切关注抗菌药物的MIC值变化,以此延长药物的使用寿命。     

Impact of antibiotic timing relative to percutaneous aspiration on culture positivity rate and clinical outcomes: A retrospective study of patients with pyogenic liver abscess

The optimal timing of antibiotic administration relative to liver abscess aspiration is debatable. This retrospective cohort study investigated whether the timing affects the abscess culture positivity rate and clinical outcomes. Twenty-nine patients with 30 percutaneously drained liver abscess cases were analyzed. Antibiotics were administered before aspiration (pre-aspiration antibiotics) in 22 cases and following aspiration (post-aspiration antibiotics) in 8 cases (i.e., 1 patient underwent aspiration twice, both before and following antibiotics). Both groups demonstrated similar patient characteristics, short time to aspiration, and high antibiotic appropriateness. Most patients were immunocompetent and non-septic. Pre-aspiration antibiotics did not reduce the culture yield (95% with pre-aspiration antibiotics vs. 100% with post-aspiration antibiotics; p = 1). Post-aspiration antibiotics were not associated with higher mortality, longer length of hospitalization, or an increased rate of clinical deterioration following aspiration. With appropriate antibiotic and aspiration, antibiotics timing can be either before or after aspiration without compromising the culture positivity rate and clinical outcomes.     

Utility of Urine and Blood Cultures in Pyelonephritis

Objective: To determine how often the results of urine and blood cultures led to changes in antibiotic therapy for patients discharged from the hospital with the diagnosis of pyelonephritis.
Methods: A retrospective chart review was performed of consecutively admitted patients, 10–90 years old, with an ICD-9 discharge diagnosis of acute pyelonephritis. All patients were admitted to a university-based, tertiary care center and a large HMO medical center from 1993 to 1994. The association of urine and blood culture results with a change in antibiotic therapy was assessed.
Results: Of the 194 patients who met inclusion criteria, 189 (97%) had urine cultures obtained at the time of admission and 139 (71%) had blood cultures obtained. Ampicillin, gentamicin, or both were given as initial antibiotics 81% of the time, and isolated organisms from urine or blood were sensitive to the empiric antibiotics 95% of the time. Most (171/189; 90%) urine cultures were positive, but only 9 (5%) of these led to a change in antibiotic therapy. 80% of the urinary pathogens were Escherichia coli , 5% Enterococcus, 5% Proteus, and 4% Klebsiella. Only 40 (29%) of the 139 blood cultures were positive; none prompted a change in antibiotics. There were no cases in which blood and urine cultures grew different pathogens.
Conclusions: Urine cultures are useful in directing antibiotic therapy in patients with the discharge diagnosis of acute pyelonephritis and support a change in therapy in 5% of cases. Among the patients in this study, blood culture results did not lead to changes in antibiotic therapy. These findings warrant prospective, mul-ticenter evaluation.     

59例人体血液及静脉导管培养葡萄球菌阳性病历污染率及临床意义

目的:调查研究对于血液或静脉导管培养葡萄球菌阳性、临床上使用抗生素的情况及其报警时间与葡萄球菌感染之间的关联,从而为临床治疗提供参考依据.方法:对北京协和医院2010年血液和静脉导管培养葡萄球菌阳性的59例住院病历进行系统回顾性分析.结果:59例血液及静脉导管培养葡萄球菌阳性,有7例(污染菌)未给予抗生素治疗,其余52例(污染菌和致病菌)都使用了抗生素,且大多数病人预后良好.污染菌与病原菌的报警时间有显著差异(P<0.05),污染菌报警时间长于病原菌.结论:葡萄球菌在血培养中的假阳性率比较高,尤其是凝固酶阴性葡萄球菌,因此采血培养标本时应严格规范操作以减少其污染,其阳性结果也应综合分析患者的临床症状、体征及实验室检查来判断是否为污染菌,以避免临床上不必要抗生素的滥用,从而也可防止葡萄球菌的高耐药率的问题.     

Peritoneal fluid cultures rarely alter management in patients with ascites

Study objective: The objective of this study is to determine if the peritoneal fluid culture results in the ascites patient being evaluated for spontaneous bacterial peritonitis (SBP) in the Emergency Department (ED) are used by the inpatient physician to appropriately alter empiric antibiotic treatment. Methods: We performed a retrospective study of all ascitic fluid samples sent from the ED between January 1, 2002 and December 31, 2004. Exclusion criteria included peritoneal fluid samples sent from peritoneal dialysis patients and those undergoing diagnostic peritoneal lavage for trauma. Medical records were examined to determine culture results, initial antibiotic choices, and subsequent changes in antibiotics by the inpatient physician in response to the culture results. The primary outcome measure was the percentage of cases in which ED peritoneal fluid culture results caused inpatient physicians to appropriately change antibiotic coverage. Results: There were 201 ascitic fluid samples, of which 7 (3.5%; 95% confidence interval [CI] 1.4%–7.0%) had a pathogen identified. Of these, only 1 (0.5%; 95% CI .01%–2.4%) resulted in an appropriate change in empiric antibiotic therapy. Although there were additional opportunities for appropriately using the culture results to change the antibiotic coverage in 2 (1%; 95% CI 0.1%–3.6%) patients, coverage was not changed. In fact, it was changed inappropriately in these 2 patients, and in an additional patient on appropriate empiric therapy. Conclusions: The yield from ascitic fluid cultures was low, and when positive, did not appropriately change management according to microbiologic criteria.     

Management of pediatric patients with otitis media in the emergency department

We designed a study to evaluate the pattern and appropriateness of the use of drugs and the laboratory data or procedure in 100 patients (age 1 month-17 years) seen in the emergency department with the diagnosis of otitis media during 178 visits. Patients were selected randomly among those seen during 1983. All patients had usual signs and symptoms of otitis media. Antibiotics prescribed were amoxicillin during 94 visits, trimethoprim/sulfamethoxazole during 33 visits, erythromycin/sulfisoxazole during 14 visits, cefaclor during 5 visits and ampicillin during 3 visits. Due to incomplete dose strength of regimen, only 60% of antibiotic orders were evaluable. The antibiotic doses were within the recommended range in 40% of evaluable cases. Antihistamines and decongestants were used in 28 cases. Analgesics, a variety of ear drops and vinegar irrigation solutions were utilized in 40 cases. Otoscopy was performed in all patients and tympanogram was done in two patients. Ear exudate culture was performed in 5 patients and was found to be positive in 3 cases. All patients were asked to return but only 33 patients came back for a total of 42 follow-up visits to the hospital. Otitis media was reported resolved during 31 visits, resolving during 7 visits, persisting during 3 visits and worsening during 1 visit. The results of this study demonstrate that (1) antibiotic selection was appropriate but the antibiotic orders were incomplete and the doses were frequently out of recommended range; (2) adjunctive drugs seemed to be utilized appropriately; (3) laboratory data and procedures were used appropriately.(ABSTRACT TRUNCATED AT 250 WORDS)     

腹膜透析相关感染性腹膜炎致病菌及耐药性的单中心分析

目的分析腹膜透析(简称腹透)相关感染性腹膜炎患者病原菌分布及耐药性变化。方法回顾中南大学湘雅二医院近5年来腹透相关感染性腹膜炎患者一般情况、细菌培养及药敏试验、疗效及转归,并进行统计学分析。结果①46例次病原菌培养阳性24例次(52.2%),其中G+菌9例次(37.5%),G-菌8例次(33.3%),真菌7例次(29.2%)。②G+菌对头孢类抗生素耐药率高,对万古霉素、替考拉宁等的耐药率低。G-菌对替卡西林/棒酸、阿米卡星、环丙沙星、左氧氟沙星、泰能等耐药率低。③G+菌、G-菌、培养阴性腹膜炎患者治愈率分别为88.9%、75%、73%;真菌性腹膜炎患者均拔管。结论腹膜透析相关感染性腹膜炎病原菌及耐药性已发生很大变化,需努力提高腹透液培养阳性率及腹膜炎的治愈率。     

Comparison of the effect of antibiotic treatment on the possibility of diagnosing invasive pneumococcal disease by culture or molecular methods: A prospective,observational study of children and adolescents with proven pneumococcal infection

Background: Detection of Streptococcus pneumoniae in culture specimens in invasive pneumococcal disease (IPD) may be hampered by antibiotic treatment administered before hospital admission. Realtime polymerase chain reaction (RT-PCR) assays do not require viable bacteria and are therefore less influenced by antimicrobial therapy. It is not known how long results of culture or molecular tests remain positive after antibiotic therapy is begun.Objective: The goal of the current study was to assess, in a pediatric population with a diagnosis of IPD confirmed by laboratory tests (culture and/or RT-PCR assay), the relationship between use of antibiotic therapy before hospital admission and the result of diagnostic methods (culture or molecular techniques) after admission.Methods: This prospective, observational study was conducted from April 2006 through March 2009. All children and adolescents aged 0 to 16 years, admitted to the hospital with a diagnosis of IPD confirmed by culture and/or molecular methods, were included in the study. Previous antibiotic treatment (drug, duration of therapy) was recorded. Primers and probes designed from the pneumococcal autolysin gene (lytA) were used in an RT-PCR assay for detection of S pneumoniae. Antibiotic tolerability, permanent sequelae (after a 6-month follow-up), and deaths were recorded.Results: Eighty-three patients (50 males, 33 females; 80 white, 3 Asian; mean age, 4.6 years; median age, 4.0 years; age range, 10 days-16 years) were included in the study. Fifty-four patients presented with pneumonia, 26 with meningitis/sepsis (meningitis, 19; sepsis, 7), and 3 with arthritis. Results of RT-PCR assays were positive in all 83 patients (100.0%), and 28 of the 83 patients (33.7%) also had culture-positive findings. Forty-two of the 83 patients (50.6%) had received antibiotic treatment before hospital admission, and 41 (49.4%) had not received antibiotics. Results of cultures were positive in 9 of the 42 patients with IPD (21.4%) who had received antibiotic treatment and in 19 of the 41 patients with IPD (46.3%) who had not received antibiotics (odds ratio, 3.2; 95% CI, 1.1–9.3; P = 0.03). Molecular methods appeared more sensitive than culture in any type of disease studied but particularly in patients with pneumonia, in whom the difference was statistically significant (P = 0.043). The mean length of antibiotic therapy was 1.4 days (median, 1 day; SD, 0.53 day; range, 1–2 days) for culture-confirmed cases and 4.5 days (median, 4 days; SD, 3.08 days; range, 1–15 days) for cases confirmed by RT-PCR assay (P = 0.002). No adverse reactions to the antibiotics used during home or hospital treatment were found. Two patients with meningitis suffered permanent, severe neurologic sequelae, and 1 girl died of sepsis 3 days after hospital admission. No permanent sequelae were recorded in patients with pneumonia or arthritis.Conclusion: In these children and adolescents with IPD, the molecular methods used appeared to be more sensitive than culture in any IPD patient, with a higher statistical significance in patients previously treated with antibiotics and in patients with pneumonia.     

血液透析患者股静脉置管导管感染病原菌及治疗效果分析

目的探讨血液透析（HD）患者股静脉置管后导管感染的病原菌及治疗措施。方法选取本院城东病区2011年4～12月58例股静脉置管HD患者,分别在置管后每周行导管血细菌培养和药敏试验,共观察10周。全身感染者留取外周血和导管血标本进行培养,给予经验性抗生素治疗,首选万古霉素、头孢硫脒行导管封管,血培养阳性者根据药敏结果选用抗生素,疗程为1周。结果 58例股静脉置管患者中,8例发生导管感染,感染率为13.79%;距置管感染时间为（50.25±13.76）天,主要病原菌为革兰阳性菌。导管培养阳性者使用万古霉素或者头孢硫脒封管治疗1周后,导管培养复查均转为阴性。结论导管血培养有助于早期发现HD患者股静脉导管感染,抗生素封管是治疗导管感染的有效措施。     

Selection of first-line i.v. antibiotics for acute pyelonephritis in patients requiring emergency hospital admission

Febrile urinary tract infections (UTIs) often require the intravenous infusion of antibiotics and/or hospitalization. Acute pyelonephritis (AP) is one of the most severe forms of UTI, and the antibiotics we should use as the first line and the risk factors for treatment failure remain controversial. The objective of this study was to investigate the efficacy of i.v. antibiotics selected for the treatment of febrile AP and to examine the risk factors for antibiotic resistance. We set risk factors for antibiotic treatment failure such as age, sex, and the presence of underlying urinary tract disease. We classified all cases into 49 cases of complicated AP and 24 cases of uncomplicated AP according to the presence of underlying urinary tract diseases, and examined the characteristics of the patients and the efficacy of the antibiotics used in this study. We investigated risk factors which relate to initial treatment failure and the duration of antibiotic treatment. Initial antibiotic treatment failure was significantly correlated to C-reactive protein in complicated AP and to positive blood culture in uncomplicated AP. We revealed a significant correlation between the duration of the given antibiotics and diabetes mellitus or positive blood culture in uncomplicated AP, and tazobactam/piperacillin was significantly related to prolongation of antibiotic treatment in complicated AP. In conclusion, in this study, a positive blood culture was the representative risk factor that related to both initial treatment failure and longer duration of the given antibiotics in uncomplicated AP.     

急诊肺部感染病人抗菌药物的应用探讨

目的 了解急诊肺部感染患者的病原菌及药敏情况,探讨急诊肺部感染病人抗菌药物的合理应用。方法 对医院１９９８年１～１０月４６例急诊肺部感染患者的病原体和痰细菌培养及药敏结果进行分析。结果 单一肺炎诊断９例,有兰氏阳性（Ｇ＾＋（球菌占２０．３％,肺炎支原体占６．８％,直菌占１６．９％,巨细胞病毒占６．８％,共培养出致病菌１８种,包括３９株细菌和６株真菌,其中Ｇ＾＋球菌１０株（２２．２％）,Ｇ＾－杆菌２