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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 investigate the distribution and drug resistance of bacteria in the blood and urine of patients in military hospitals in different areas and to provide a laboratory basis for rational use of antibacterial drugs. Methods A total of 1099 non-repetitive bacteria were collected from 12 military hospitals from January to December 2006. The minimum inhibitory concentrations (MICs) of antibacterials against bacteria were determined by agar dilution method. The MIC50 and MIC90 were calculated and calculated according to the American clinical laboratory Standardization Association (CLSI) 2007 criteria to determine the sensitivity rate (S%), the intermediary rate (I%), resistance rate (R%), the use of WHONET5.4 software analysis. Detection of AmpC β-lactamases (ESBLs) and 3-Aminophenolboronic acid (APB) by disk-blotting method. Results A total of 436 Gram-positive bacteria (39.7%) and 663 Gram-negative bacteria (60.3%) were obtained. The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRSCN) were 62% and 92%, respectively. No vancomycin-resistant enterococci and staphylococci were detected. The rates of Escherichia coli and Klebsiella pneumoniae producing ES-BLs were 51.1% and 45.1%, respectively. The rates of producing AmpC β-lactamases were 11.3% and 16.2%, respectively. The rates of resistance to ceftazidime, amikacin, cefotaxime, cefoxitin and levofloxacin in E. coli and K. pneumoniae in the blood were generally lower than those in the urine, whereas P. aeruginosa And Acinetobacter on the Meropenem, ceftazidime, polymyxin, minocycline resistance rates were significantly higher than the corresponding bacteria in urine. Conclusions MRSA, MRSCN, ESBLs-producing strains and AmpC-producing bacteria are more likely to be hospitalized in military hospitals. Bacteria isolated from blood and urine have different antibacterial resistance.