微生物培养及药敏解读对抗感染治疗的影响  

Antibiotic susceptibility tests for treatment of bacterial infection

作　　者：赵岚[1] 丁士标[2] 谢利军[1] 潘亚萍[2] 

机构地区：[1]杭州市红十字会医院院感科,310003 [2]杭州市红十字会医院检验科,310003

出　　处：《浙江医学》2014年第12期1063-1066,共4页Zhejiang Medical Journal

摘　　要：目的：探讨解读与遵从微生物培养及药敏结果对感染治疗效果的影响，就微生物实验室与临床合作共同提高病原学诊断水平提出对策。方法回顾性调查非ICU住院的264例有药敏报告的感染病例，调查该病例使用的抗菌药物与微生物药敏解读的符合度，以是否遵从药敏结果分组观察，比较患者基本情况、治疗72h的疗效、预后及细菌耐药机制的影响差异。结果29.55%的患者选择与药敏一致的抗菌药物；30.30%的患者根据药敏调整使用抗菌药物；40.15%的患者仍使用与药敏不一致的抗菌药物。遵从药敏组和非遵从组患者的血WBC计数有统计学差异[（8.5±5.1）×109/L vs （6.8±4.7）×109/L，P=0.011]，两组72h疗效有差异（P=0.016），而转归无差异（P=0.112）。比较感染产超广谱β-内酰胺酶（ESBL）的大肠埃希菌和肺炎克雷伯菌的患者47例，以及感染产AmpC酶的阴沟肠杆菌病例14例，发现是否针对耐药机制使用抗菌药物与患者转归均有统计学差异（P=0.026、0.023）。结论正确的微生物培养及药敏结果解读，尤其是耐药表型的判断对感染治疗效果有影响。对于重症或耐药菌感染的抗菌药物选择，需要临床和微生物人员的共同合作，提高病原学诊断水平。Objective To review the therapeutic outcomes of bacterial infection in relation to results of antibiotic suscepti-bility tests. Methods Clinical data of 264 non- ICU hospitalized patients with bacterial infection were retrospectively reviewed in relation to results of susceptibility reports. The correlation of clinical outcomes with the compliance of susceptibility test results was analyzed. Results The selection of antibiotics was according to susceptibility results in 29.55%cases;the use of antibiotics was based on modified susceptibility test in 30.30%cases;while in 40.15%cases the antibiotics use was not consistent with sus-ceptibility. There was significant difference in WBC counts between compliance and non- compliance groups [（6.8±4.7）×109/L vs （8.5±5.1）×109/L, P=0.011]. There was significant difference in 72 h efficacy between two groups（P=0.016）;however, no dif-ference in outcome between two groups （P=0.112）. For patients infected with extended- spectrum β- lactamase （ESBL）- pro-ducing Escherichia coli and Klebsiel a pneumoniae （n=47） and patients infected with AmpC β- lactamases- producing Enter-obacter cloacae （n=14） there were significant differences in therapeutic outcomes between compliance and non- compliance groups （P=0.026 and 0.023）. Conclusion Correct interpretation and application of microbial susceptibility tests can improve therapeutic efficacy and outcomes for patients with bacterial infection.

关 键 词：微生物培养 解读 抗菌药物 影响 

分 类 号：R446.5[医药卫生—诊断学]