重症监护病房311株分离菌菌群分布及药敏试验结果分析

目的：调查分析安徽省铜陵市人民医院重症监护病房（ICU）分离致病菌的菌群种类特点及耐药状况,为临床合理使用抗菌药物提供参考。方法：对本院ICU 2005年1月-2007年12月送检标本中分离的311株病原菌株分布及耐药状况进行分析。结果：在311株病原菌中,有G-杆菌237株（76.21%）,G＋球菌74株（23.79%）。G-杆菌主要有鲍曼不动杆菌84株（27.01%）、铜绿假单胞菌40株（12.86%）、肺炎克雷伯菌28株（9.0%）、嗜麦芽窄食单胞菌26株（8.36%）、大肠埃希菌15株（4.82%）等,其中,产超广谱β-内酰胺酶（ESBLs）大肠埃希菌和肺炎克雷伯菌检出率分别达73.33%（11/15）和39.29%（11/28）。G＋球菌主要有凝固酶阴性葡萄球菌27株（8.68%）、肠球菌30株（9.65%）、金黄色葡萄球菌13株（4.18%）等,其中,耐甲氧西林凝固酶阴性葡萄球菌检出率达96.30%（26/27）,而耐甲氧西林金黄色葡萄球菌检出率仅为23.08%（3/13）。ICU病房感染以G-菌为主,大部分病原菌呈现高耐药和多重耐药的特点。G＋球菌对利福平、氯霉素、磷霉素、呋喃妥因仍较敏感,未见耐万古霉素和替考拉宁的G＋球菌株。结论：本院ICU病房菌群分布及耐药状况与铜陵地区医院平均水平有差异,以鲍曼不动杆菌、铜绿假单胞菌等非发酵菌最为多见。定期对ICU病房进行细菌流行病学调查和耐药分析对临床经验用药、减少新的耐药菌株出现具有指导作用。     

334株凝固酶阴性的葡萄球菌耐药监测

目的回顾性分析2012年我院患者感染的凝固酶阴性葡萄菌（CNS）对常用抗菌药物的耐药情况。方法菌种鉴定及药敏采用西门子Micro Scan Walkaway一40系统;采用瑞美LIS系统进行统计分析,并导出＊xls文件进行处理。结果2012年我院共分离出CNS334株;其中,表皮葡萄球菌138株（41．3％）,溶血性葡萄球菌70株（21．0％）,松鼠葡萄球菌52株（15．6％）,人葡萄菌人亚种23株（6．9％）,木糖葡萄球菌16株（4．8％）,耳葡萄球菌9株（2．7％）,其他CNS26株（7．8％）;86．3％（119／138）耐甲氧西林表皮葡萄球菌,77．1％（56／70）耐甲氧西林溶血眭葡萄球菌,90．4％（47／52）耐甲氧西林松鼠葡萄球菌,60．9％（14／23）耐甲西林人葡萄球菌亚种,81．3％（13／16）耐甲氧西林木糖葡萄球菌,66．6％（6／9）耐甲氧西林耳葡萄球菌;检出9株耐万古霉素CNS和2株对耐万霉素中介的CNS;所有CNS对利奈唑胺还保持100％敏感。结论我院CNS耐药状况非常严峻,应加强临床耐药性监测,为临床用药提供理论依据。     

2014年天津市血流感染细菌耐药监测

目的：研究天津市血流感染细菌耐药分布及耐药性。方法：收集2014年度天津市45家医院血标本来源细菌药敏结果,用CLSI 2014年标准判读,WHONET 5.6进行药物敏感性分析。结果：分离共计4 772株细菌,其中革兰阳性菌2 038株,占42.7%,革兰阴性菌2 734株,占57.3%,葡萄球菌属1 409株,占29.5%,肠球菌属335株占7.0%,肠杆菌科细菌2 248株,占47.1%,非发酵菌438株,占9.2%,肺炎链球菌35株,占0.7%。最常见细菌依次为大肠埃希菌（27.3%）、凝固酶阴性葡萄球菌（23.8%）、肺炎克雷伯菌（12.1%）、金黄色葡萄球菌（5.6%）、铜绿假单胞菌（4.1%）。耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）和耐甲氧西林金黄色葡萄球菌（MRSA）的检出率分别为78.5%和25.3%。MRSA和MRCNS的耐药率明显高于甲氧西林敏感金黄色葡萄球菌（MSSA）和甲氧西林敏感凝固酶阴性葡萄球菌（MSCNS）。未发现对万古霉素耐药的葡萄球菌。粪肠球菌和屎肠球菌对万古霉素敏感率分别为100%和98.1%,共检出耐万古霉素的屎肠球菌（VRE）3株。大肠埃希菌对亚胺培南的敏感率为98.7%,肺炎克雷伯菌对亚胺培南的敏感率为95.3%。大肠埃希菌和肺炎克雷伯菌中产ESBLs株分别占60.1%和33.3%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为21.6%和17.5%。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为39.6%和49.3%。结论：本年度所分离血培养细菌的耐药较为普遍,加强耐药性监测,指导临床合理使用抗菌药物十分重要。     

2012年绵阳市中心医院临床常见细菌耐药性监测

目的：了解我院目前细菌耐药状况,为临床合理使用抗菌药物提供参考依据。方法：对2012年我院临床分离的细菌耐药数据进行回顾性分析。结果：2012年我院分离出细菌4754株,其中革兰阴性菌3504株（占73．7％）,革兰阳性菌l250株（占26．3％）。大肠埃希菌（1030株）、肺炎克雷伯菌（779株）、金黄色葡萄糖球菌（502株）、铜绿假单胞菌（444株）、鲍曼不动杆菌（426株）捡出细菌数居前5位,为我院临床常见细菌,总菌株数占检出细菌总数的66．9％;对大肠埃希菌、肺炎克雷伯菌等临床常见发酵菌,亚胺培南仍是耐药率最低的药物;对非发酵菌则需根据药物敏感性试验选择治疗药物;对葡萄球菌属耐药率最低的是万古霉素。耐甲氧西林金黄色葡萄球菌（MRSA）检出率为21．9％,耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）检出率为87．9％。结论：细菌耐药性较2011年有所下降,但总的耐药形势仍然严峻,特别是非发酵菌的耐药率仍较高,临床选择药物治疗方案困难,合理使用抗菌药物任重道远。     

67例儿童血流感染病原菌分布及耐药性分析

目的：了解儿童血流感染病原菌分布及耐药情况,指导临床合理使用抗菌药。方法：回顾性分析2009～2010年67例儿童血流感染的病原菌和药敏结果。结果：67例儿童血流感染患者分离到病原菌69株,主要病原菌依次为：葡萄球菌23株（33.3%）、大肠埃希菌12株（17.4%）、肺炎克雷伯菌和铜绿假单胞菌各7株（10.1%）。葡萄球菌中凝固酶阴性葡萄球菌（CNS）13株（56.5%）,金黄色葡萄球菌10株（43.5%）。药敏试验显示：CNS、金黄色葡萄球菌对青霉素、氨苄西林、红霉素、环丙沙星、庆大霉素耐药率较高,对头孢菌素类、氨基糖苷类药及喹诺酮类药有较高敏感性;革兰阴性（G-）杆菌对头孢菌素类抗菌药（除头孢吡肟外）、复方磺胺甲噁唑、环丙沙星、左氧氟沙星、庆大霉素、阿米卡星耐药率均在57%以上,对亚胺培南敏感率最高。结论：儿童血流感染的病原菌以G-杆菌为主,主要是条件致病菌,革兰阳性球菌中以葡萄球菌感染率最高。临床上应依据药敏结果合理使用抗菌药,加强耐药性监测。     

泉州地区9家医院2008年临床常见病原菌的分布及耐药性监测

目的：调查分析福建泉州地区9家医院临床标本常见病原菌的分布及其对常用抗菌药的耐药性状况,为临床合理应用抗菌药提供依据。方法：对泉州地区9家医院2008年1～12月临床送检的8943例标本分离菌株及耐药监测资料进行分析。结果：送检标本阳性率为26．77％。2394株临床分离到G-菌773株（32．31％）,G-菌1258株（52．54％）,真菌363株（15．15％）。以凝固酶阴性葡萄球菌、铜绿假单胞菌、肠杆菌属、克雷伯菌属、大肠埃希菌、金黄色葡萄球菌最为常见。亚胺培南是对G-杆菌作用最强的一种抗菌药,利奈唑胺是对G＋菌球菌作用最强的一种抗菌药,G^＋球菌对万古霉素、替考拉宁、利奈唑胺、呋喃妥因的敏感性高。未检出耐利奈唑胺金黄色葡萄球菌、凝固酶阴性葡萄球菌和肠球菌。结论：本地区细菌耐药性较为严峻,应该严格执行《抗菌药物临床应用指导原则》,根据各类抗菌药的适应证,根据病原菌种类及细菌药敏实验结果选择抗菌药,以保证抗菌药的合理应用。     

大型综合性医院524株细胞的分离鉴定及耐药性调查

目的：调查综合医院常用菌株对各种上用抗生素耐药率的状况，为合理使用抗菌素控制感染提供依据。方法：应用WHONET－4软件对临床分离菌的药敏结果进行统计分析。结果：分离菌株前六位依次为大肠埃希氏菌、铜绿假单胞菌、金黄色葡萄球菌，凝固酶阴性葡萄球菌，肠球菌、肺炎克雷伯氏菌。检测它们对13抗性素的耐药性。结果显示革兰氏阳性球菌除肠球菌对万古霉素耐药率有所上升（9．15），未见有耐万古霉素的葡萄球菌株出现。革兰氏阴性杆菌（包括铜绿假单胞菌）仍对泰能、头孢他啶、丁胺卡那最为敏感。耐苯唑西林的葡萄球菌对绝大多数抗生素耐药率均在50％以上，大肠埃希氏菌对环丙沙星的耐药率直线上升，已达63．9％，结论：定期系统的耐药监测对临床合理用药十分必要。     

综合 ICU 医院获得性肺炎感染菌株及耐药性分析

目的：分析医院综合重症监护病房（GICU ）医院获得性肺炎（HAP）感染菌株特点及耐药情况。方法回顾性分析GICU收治61例 HAP患者的感染菌株及其对抗菌药物耐药性。结果61例H A P患者中,共检出213株菌。革兰阴性杆菌99株（46.5％）,以鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌为主;革兰阳性球菌81株（38.0％）,以肠球菌、金黄色葡萄球菌、表皮葡萄球菌和溶血葡萄球菌为主;真菌33株（15.5％）,以白色念珠菌和非白色念珠菌为主。鲍曼不动杆菌株较多对抗生素多重耐药,未发现耐万古霉素的肠球菌株和葡萄球菌株。结论应根据细菌病原学及抗菌药物耐药性,合理选择抗菌药物,控制GICU内 HAP感染的发生,减少耐药菌的出现。     

下呼吸道感染病原菌分布及耐药性分析

目的探讨下呼吸道感染病原菌分布及耐药状况,为治疗下呼吸道感染疾病提供可靠依据,指导临床合理用药。方法对下呼吸道感染患者痰培养分离出的1203株病原菌及药敏试验结果进行回顾性分析。结果下呼吸道感染病原菌中铜绿假单胞菌检出率最高,为301株（25．0％）;其次为肺炎克雷伯菌268株（22．3％）、鲍曼不动杆菌186株（15．5％）、大肠埃希菌116株（9．6％）、金黄色葡萄球菌111株（9．2％）;对亚胺培南的耐药率：大肠埃希菌最低为0、肺炎克雷伯菌为0．9％。铜绿假单胞菌和鲍曼不动杆菌的耐药率较高,未发现耐万古霉素金黄色葡萄球菌。结论下呼吸道感染主要病原菌为铜绿假单胞菌和肺炎克雷伯菌,对头孢类和喹诺酮类药物的耐药率明显较高,临床应依据药敏报告结果合理选用抗菌药物。     

某院2018年—2020年106例肝胆外科多重耐药菌感染患者多重耐药菌的分布及其耐药性分析

目的：分析2018年—2020年医院106例肝胆外科多重耐药菌感染患者多重耐药菌的分布及其耐药情况。方法：收集2018年1月—2020年12月景德镇市第一人民医院肝胆外科收治的106例多重耐药菌感染患者的临床资料,分析常见多重耐药菌的种类及其耐药特点。结果：106例多重耐药菌感染患者分离出多重耐药菌112株,其中大肠埃希菌53株（占47.32%）、肺炎克雷伯菌19株（占16.96%）、鲍曼不动杆菌15株（占13.39%）、铜绿假单胞菌14株（占12.50%）和耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aureus,MRSA）11株（占9.82%）;2018年—2020年,大肠埃希菌的检出率上升明显,肺炎克雷伯菌和铜绿假单胞菌则呈下降趋势,鲍曼不动杆菌和MRSA基本保持不变;药敏结果显示,大肠埃希菌对哌拉西林-他唑巴坦钠、亚胺培南的耐药率较低（<15.00%）,肺炎克雷伯菌对亚胺培南、头孢吡肟、头孢他啶、哌拉西林-他唑巴坦钠、阿米卡星和妥布霉素的耐药率较低（<20.00%）,鲍曼不动杆菌对除亚胺培南（33.33%）外的...     

Emergence of resistance to carbapenems in Acinetobacter baumannii in Europe: clinical impact and therapeutic options

Despite having a reputation of low virulence, Acinetobacter baumannii is an emerging multidrug-resistant (MDR) pathogen responsible for community- and hospital-acquired infections that are difficult to control and treat. Interest in this pathogen emerged about one decade ago because of its natural MDR phenotype, its capability of acquiring new mechanisms of resistance and the existence of nosocomial outbreaks. Recent advances in molecular biology, including full genome sequencing of several A. baumannii isolates, has led to the discovery of the extraordinary plasticity of their genomes, which is linked to their great propensity to adapt to any environment, including hospitals. In this context, as well as the increasing antimicrobial resistance amongst A. baumannii isolates to the last-line antibiotics carbapenems and colistin, therapeutic options are very limited or absent in some cases of infections with pandrug-resistant bacteria. However, a large proportion of patients may be colonised by such MDR bacteria without any sign of infection, leading to a recurrent question for clinicians as to whether antibiotic treatment should be given and will be effective in the presence of resistance mechanisms. The worldwide emergence of A. baumannii strains resistant to colistin is worrying and the increasing use of colistin to treat infections caused by MDR bacteria will inevitably increase the recovery rate of colistin-resistant isolates in the future. Current knowledge about A. baumannii, including biological and epidemiological aspects as well as resistance to antibiotics and antibiotic therapy, are reviewed in this article, in addition to therapeutic recommendations.     

Multidrug-resistant Gram-negative bacteria: how to treat and for how long

The emergence of multidrug-resistant (MDR) Gram-negative bacilli creates a big problem for the treatment of nosocomial infections. As the pharmaceutical pipeline wanes, the only therapeutic options are two revived antibacterials (colistin and fosfomycin), a newer one (tigecycline) and an early-phase neoglycoside (ACHN-490). Polymyxins, known since 1947, are mostly represented by polymyxin E (colistin), which has recently gained a principal position in the management of the most difficult-to-treat MDR Gram-negative pathogens -Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae. However, despite promising therapeutic results in 59-75% of cases, the reported studies share common drawbacks, i.e. the absence of a control group, their retrospective nature, variable dosing and duration of therapy, simultaneous administration of other antibiotics in >70% and a lack of resistance development monitoring. The necessity for well-designed prospective clinical trials is therefore urgent. Fosfomycin is active in vitro against MDR Enterobacteriaceae, including a high proportion of P. aeruginosa; however, clinical experience is lacking with the parenteral formulation in MDR infection and on the best combinations to prevent resistance development. Tigecycline, which is active against MDR Enterobacteriaceae and A. baumannii, has shown satisfactory clinical experience. However, dosage adjustment is required because of low blood levels. ACHN-490, which has promising in vitro activity against MDR K. pneumoniae, is still in early phase II trials in urinary tract infections. Meanwhile, the strict application of infection control measures is the cornerstone of nosocomial infection prevention, and antibiotic stewardship, exemplified by appropriate duration of therapy and de-escalation policies, should not be overlooked.     

Antimicrobial treatment for Intensive Care Unit (ICU) infections including the role of the infectious disease specialist

Between 5 and 10% of patients admitted to acute care hospitals acquire one or more infections, and the risks have steadily increased during recent decades. Three types of infection account for more than 60% of all nosocomial infections: pneumonia, urinary tract infection and primary bloodstream infection, all of them associated with the use of medical devices. Nearly 70% of infections are due to micro-organisms resistant to one or more antibiotics (multidrug resistant or MDR). A higher incidence of inappropriate antibiotic therapy is expected when infections are caused by antibiotic-resistant micro-organisms and initial inappropriate empirical therapies, and the further need to modify them substantially increases the mortality risk. Despite new antibacterial agents such as linezolid, and also tigecycline and daptomycin, now being available for the treatment of infections due to MDR micro-organisms, the best strategy for improving the cure rate and minimising the development of resistance, probably remains the infectious disease specialist consultation.     

Multidrug resistance to antimicrobials as a predominant factor influencing patient survival

The impact of multidrug resistance to antimicrobials was assessed in a cohort of 243 patients with microbiologically documented infections by a variety of susceptible and multidrug-resistant (MDR) species. Multidrug resistance was defined as resistance to more than two antimicrobial agents of different chemical structure. Cox regression analysis was performed to define differences and the significance of any predisposing factors. Overall survival of patients infected by susceptible isolates was prolonged compared with patients infected by MDR isolates (P = 0.013). Mortality rates of infections caused by susceptible and MDR isolates were 4.87% and 16.15%, respectively (P = 0.013); the higher mortality rate for MDR isolates was more pronounced for infections by Klebsiella pneumoniae and Pseudomonas aeruginosa. Mean (± standard error (S.E.)) survival of patients infected by susceptible and MDR isolates in patients without signs of severe sepsis was 28 days and 27.29 ± 0.35 days, respectively (P = not significant). Mean (± S.E.) survival of patients with severe sepsis caused by susceptible and MDR isolates was 7.70 ± 4.62 days and 10.45 ± 2.18 days, respectively (P = 0.048). Diabetes mellitus type 2, the presence of severe sepsis and any underlying malignancy were the most important risk factors affecting survival. It is concluded that infections by MDR isolates were accompanied by higher mortality rates and decreased survival compared with infections by susceptible isolates. Diabetes mellitus type 2 and underlying malignancies were significant co-morbid conditions, whereas survival after infection by susceptible isolates was particularly decreased in the event of severe sepsis.     

Treatment of Acinetobacter infections

Importance of the field: Acinetobacter baumannii has emerged as a major cause of healthcare-associated infections. It commonly presents resistance to multiple antimicrobial agents, occasionally including carbapenems and polymyxins, and hence, it is considered the paradigm of multidrug-resistant (MDR) or pandrug-resistant (PDR) bacterium. MDR A. baumannii is a rapidly emerging pathogen, especially in the intensive care setting, causing infections including bacteremia, pneumonia/ventilator-associated pneumonia (VAP), meningitis, urinary tract infection, central venous catheter-related infection, and wound infection.

Areas covered in this review: All potential antimicrobial agents that are available for the treatment of Acinetobacter infections are presented. Emphasis was given to the management of nosocomial infections due to MDR A. baumannii and its close relatives, spp. 3 and 13TU. Areas covered include bloodstream infections, pneumonia or VAP, meningitis, urinary tract infection, skin and soft-tissue or wound infections due to Acinetobacter.

What the reader will gain: The antibiotics that are usually effective against A. baumannii infections include carbapenems, polymyxins E and B, sulbactam, piperacillin/tazobactam, tigecycline and aminoglycosides. Carbapenems (imipenem, meropenem, doripenem) are the mainstay of treatment for A. baumannii, though carbapenem-resistant Acinetobacter strains have increasingly been reported worldwide in recent years. However, although well-designed trials of new therapeutic approaches are certainly required, the most important factor necessary to guide clinicians in their choice of empirical or targeted therapy should be knowledge of the susceptibility patterns of strains present in their own geographical area.

Take home message: Pooled data suggest that infections caused by A. baumannii, especially those with inappropriate treatment, are associated with considerable attributable mortality. The optimal treatment for A. baumannii nosocomial infections has not been established, especially for MDR strains. Therefore, well-designed clinical studies are necessary to guide clinicians on decisions regarding the best therapeutic approach for patients with MDR A. baumannii infections. In addition, new experimental studies are warranted to evaluate the activity and safety of peptides and other novel antibacterial agents for A. baumannii infections.     

113例肠杆菌科细菌血流感染临床特征与病原分析

目的 探讨肠杆菌科细菌血流感染临床特征和病原分布，为经验抗菌治疗及合理用药管理提供参考。方法 回顾性调查2015年1月1日—2018年12月31日入住嵊州市中医院确诊为肠杆菌科细菌血流感染的所有成年病例共113例，根据致病菌是否为多重耐药，分为MDR组及非MDR组，分析患者病情、感染状况、病原检测与药敏结果。结果 113例肠杆科细菌血流感染MDR组62例，非MDR组51例。72例(63.7%)为社区获得感染，79.6%(90/113)由腹腔和泌尿系感染继发；APACHE II、SOFA评分均值分别为13.5(±6.6)分、5.3(±4.5)分，33例(29.2%)因感染入住重症监护室(ICU)，24例(21.2%)存在感染性休克。MDR组感染前2周内抗菌药物暴露比例显著高于非MDR组(P<0.001)，而平均CRP水平更低(P<0.001)。临床分离菌以大肠埃希菌居首，占50.4%(57/113)，肺炎克雷伯菌占36.3%(41/113)，MDR组肺炎克雷伯菌比例明显低于非MDR组；113株肠杆菌科细菌对亚胺培南、厄他培南、阿米卡星、哌拉西林/三唑巴坦等耐药率较低，分别为8.0%、8.0%、8.8%和13.3%。36例(31.9%)治疗失败，66例(58.4%)治疗有效，11例(9.7%)治愈，非MDR组治疗失败率(33.3%)略高于MDR组(29.0%)，但差异不具有统计学意义(P=0.623)。结论     

113例肠杆菌科细菌血流感染临床特征与病原分析

目的 探讨肠杆菌科细菌血流感染临床特征和病原分布,为经验抗菌治疗及合理用药管理提供参考。方法 回顾性调查2015年1月1日—2018年12月31日入住嵊州市中医院确诊为肠杆菌科细菌血流感染的所有成年病例共113例,根据致病菌是否为多重耐药,分为MDR组及非MDR组,分析患者病情、感染状况、病原检测与药敏结果。结果 113例肠杆科细菌血流感染MDR组62例,非MDR组51例。72例(63.7%)为社区获得感染,79.6%(90/113)由腹腔和泌尿系感染继发;APACHE II、SOFA评分均值分别为13.5(±6.6)分、5.3(±4.5)分,33例(29.2%)因感染入住重症监护室(ICU),24例(21.2%)存在感染性休克。MDR组感染前2周内抗菌药物暴露比例显著高于非MDR组(P<0.001),而平均CRP水平更低(P<0.001)。临床分离菌以大肠埃希菌居首,占50.4%(57/113),肺炎克雷伯菌占36.3%(41/113),MDR组肺炎克雷伯菌比例明显低于非MDR组;113株肠杆菌科细菌对亚胺培南、厄他培南、阿米卡星、哌拉西林/三唑巴坦等耐药率较低,分别为8.0%、8.0%、8.8%和13.3%。36例(31.9%)治疗失败,66例(58.4%)治疗有效,11例(9.7%)治愈,非MDR组治疗失败率(33.3%)略高于MDR组(29.0%),但差异不具有统计学意义(P=0.623)。结论 本院肠杆菌科细菌血流感染总体病情较重;病原以大肠埃希菌、肺炎克雷伯菌为主,对哌拉西林/三唑巴坦、阿米卡星、亚胺培南、厄他培南等耐药率较低;血流感染前抗菌药物暴露是MDR的重要危险因素;临床应重视感染灶的清除和引流、迁移灶的及时发现与干预,这有利于提高治疗效果,同时降低对抗菌药物的依赖。     

北京地区2家医院临床分离革兰阴性菌对头孢哌酮/舒巴坦的耐药性特征研究

摘要：目的 探讨头孢哌酮/舒巴坦对不同部位临床分离革兰阴性菌的耐药特点,为临床治疗选择提供依据。方法 回顾 分析北京两家医院2017年1月-2020年12月的耐药监测数据,使用Whonet 5.6软件分析不同感染部位的病原菌特点及头孢哌酮/ 舒巴坦对常见革兰阴性菌的耐药率,并与其他β-内酰胺类抗生素、酶抑制剂合剂以及常用抗生素的耐药率进行比较,CHISS统 计学软件对结果进行统计学分析。结果 泌尿道感染、血流感染及腹腔感染的病原菌以大肠埃希菌占绝对优势分别为56.5%、 36.5%和40.2%,而中枢神经系统感染以鲍曼不动杆菌为主(31.9%);临床常见病原菌对头孢哌酮/舒巴坦整体耐药率：大肠埃希 菌11.9%(37/310)、铜绿假单胞菌24.1%(71/295)、肺炎克雷伯菌24.6%(70/285)和鲍曼不动杆菌51.2%(348/680);对临床治疗棘手 的MDR鲍曼不动杆菌、铜绿假单胞菌、产超广谱β-内酰胺酶大肠埃希菌、肺炎克雷伯菌及碳青霉烯类耐药大肠埃希菌和肺炎克 雷伯菌的耐药率分别为：62.7%(256/409)、46.4%(55/119)、19.3%(30/155)、52.7%(71/135)、73.3%(6/8)和94.7%(59/62),耐药率 均显著低于第三代头孢菌素及其他加酶抑制剂复合抗生素(P＜0.05);研究的4种革兰阴性病原菌近4年对头孢哌酮/舒巴坦耐药率 增高明显。结论 临床常见革兰阴性病原菌不同菌种间对头孢哌酮/舒巴坦耐药率差异较大,可作为泌尿道感染、血流感染、腹 腔感染及脑脊液感染经验用药的首选;但需加强监测,采取策略防止其耐药率的快速上升。     

临床药师会诊多重耐药及泛耐药细菌感染79例分析

目的:调查临床药师对多重耐药及泛耐药细菌感染病例进行会诊的效果,探讨多重耐药及泛耐药细菌感染的特点与治疗策略。方法:回顾性调查79例经临床药师会诊的多重耐药、泛耐药细菌感染病例,分析病原菌分布、耐药情况、治疗方案、治疗结果及药学监护相关情况。结果:临床药师提供的用药方案接受率为91.1%,其中临床有效率为93.94%,细菌清除率为67.42%,没有出现菌群失调;泛耐药菌以鲍曼不动杆菌及铜绿假单胞菌为主,多重耐药菌以产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌、耐甲氧西林金黄色葡萄球菌(MRSA)及阴沟肠杆菌为主,对多种临床常用抗菌药物有高度耐药性;对多重耐药菌,亚胺培南/西司他丁、万古霉素、头孢西丁、左氧氟沙星、阿米卡星等有较好效果;4例泛耐药菌感染病例采用哌拉西林/他唑巴坦+左氧氟沙星、头孢美唑+阿米卡星、头孢西丁+磷霉素,取得了治愈的效果。结论:临床药师参与多重耐药感染病例治疗取得良好效果,应充分重视临床药师工作,发挥其重要作用;需高度重视泛耐药菌、多重耐药菌的耐药问题,可采用选择敏感率高的药物、联合用药、口服肠道活菌制剂等策略进行治疗,同时应加强抗菌药物合理应用和分级使用等管理措施,控制耐药细菌的蔓延。     

Controlling multiple-drug-resistant organisms at the hospital level

Nosocomial infections due to multiple-drug-resistant (MDR) organisms are associated with poor patient outcomes and increased healthcare cost. The natural history of an MDR nosocomial infection can be characterised in four steps. First is the introduction of MDR organisms into the patient's normal flora as a consequence of inappropriate infection control practices. Second is the selection of MDR organisms due, in part, to inappropriate antibiotic therapy. Third is the development of an MDR infection due, in part, to inappropriate invasive techniques. The fourth step occurs when the patient has developed poor clinical outcomes due, in part, to inappropriate antibiotic therapy. At the local hospital level, a multidisciplinary MDR control programme should be developed with the goals to optimise local surveillance of MDR organisms, improve local infection-control practices, and control local antimicrobial use. Without achieving these three goals, hospitals will not be able to control the spread of MDR organisms.