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目的提高合理应用抗菌药物及控制院内感染的水平。方法调查461株院内感染致病菌的分布、绿脓杆菌对抗菌药物的耐药率、耐药趋势、抗菌药物的敏感试验、最低抑菌浓度(MIC)、药动学、药效学、细菌清除率及不良反应。结果绿脓杆菌是北京医院院内感染主要致病菌、也是北京市5个综合医院感染病人的主要致病菌。32株院内感染绿脓菌株对抗菌药物耐药率如下:Gentamicin(GM)、Amikacin(AK)及Piperacillin(PIP)50％～56％、Ceftazidime(CAZ)及Sulperazon(SUPZ)18.8％,tienam(泰能)12.5％,Ciprofloxacin(CIP)6.5％。MIC(mg/L) 值如下:CIP 0.25～4,CAZ泰能4～32。从32株中的8株绿脓菌株中提取到耐药质粒。PIP治疗中度下呼吸道感染(下感)病例有效率63.3％,CIP及CAZ治疗重度下感病例的有效率各为75％及80％,泰能对耐CAZ或CIP的严重绿脓杆菌败血症并重症肺炎的有效率为76.6％。结论本研究揭示绿脓杆菌为综合医院特别是呼吸病房院内感染的主要致病菌;耐药的绿脓杆菌感染常致严重后果,是医疗中重要难题。监测细菌耐药性及对抗菌药物作出疗效评价,将为合理用药及经验治疗提供科学依据。
Objective To improve the rational use of antimicrobial agents and control of nosocomial infections. Methods The distribution of 461 pathogenic bacteria in nosocomial infections, the resistance rate of Pseudomonas aeruginosa to antibacterials, the drug resistance trend, the sensitivity test of antibacterials, the minimum inhibitory concentration (MIC), pharmacokinetics, pharmacodynamics, bacteria Clearance and adverse reactions. Results Pseudomonas aeruginosa was the main pathogen of nosocomial infection in Beijing Hospital and the main pathogen of infection in 5 general hospitals in Beijing. The antibiotic resistance rates of 32 strains of P. aeruginosa isolated from hospital were as follows: Gentamicin (GM), Amikacin (AK) and Piperacillin (PIP) 50% -56%, Ceftazidime (CAZ) and Sulperazon (SUPZ) 18.8% 12.5%) and Ciprofloxacin (CIP) 6.5%. MIC (mg / L) values are as follows: CIP 0.25 ~ 4, CAZ Thai 4 ~ 32. Drug-resistant plasmids were extracted from 8 strains of Pseudomonas aeruginosa from 32 strains. PIP treatment of moderate lower respiratory tract infection (down feeling) case effective rate 63.3%, CIP and CAZ treatment of severe cases of lower susceptibility were 75% and 80%, respectively, Thai to CAZ or CIP-resistant severe Pseudomonas aeruginosa sepsis and The effective rate of severe pneumonia was 76.6%. Conclusions This study revealed that Pseudomonas aeruginosa is the main pathogen of nosocomial infection in general hospitals, especially respiratory wards. The drug-resistant Pseudomonas aeruginosa infection has serious consequences and is an important medical problem. Monitoring bacterial resistance and evaluating the efficacy of antimicrobial agents will provide a scientific basis for rational drug use and experience treatment.