Mohnarin脑脊液、血液和胆汁标本常见分离菌耐药性分析  

Drug Resistance of Common Bacteria Isolated from the Mohnarin Cerebrospinal Fluid,Blood and Bile: A Literature Study

作　　者：陈丽霞[1,2] 龚国梅 林美 明德松[1,3] 

机构地区：[1]泉州医学高等专科学校基础医学部,福建泉州362011 [2]泉州医学高等专科学校护理系,福建泉州362011 [3]福建医科大学附属泉州第一医院检验科,福建泉州362000

出　　处：《中国循证医学杂志》2015年第11期1334-1342,共9页Chinese Journal of Evidence-based Medicine

基　　金：国家骨干院校建设重点资助项目(编号:XJ1306;2014XJ1313);2014年度泉州市社会发展领域科技计划项目(编号:2014Z24);2015年度泉州市社会发展领域科研与示范应用项目(编号:2015Z93)

摘　　要：目的比较分析Mohnarin脑脊液、血液、胆汁3种不同标本来源分离菌的耐药性差异,为临床合理用药提供依据。方法计算机检索CNKI和WanFang Data数据库,搜集Mohnarin脑脊液、血液、胆汁分离菌耐药性相关报告,检索时限均从2006年至2014年。由2位研究者独立筛选文献、提取资料,并采用SPSS 19.0软件对脑脊液、血液、胆汁分离菌的耐药性差异进行分析。结果 Mohnarin脑脊液标本分离的革兰阳性菌构成比远高于血液标本和胆汁标本,其差异有统计学意义(χ2=383.118,P<0.001)。脑脊液来源的大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌、鲍氏不动杆菌、粪肠球菌和屎肠球菌均表现为多重耐药,且对常用抗菌药物的耐药性明显高于血液与胆汁来源的菌株(P<0.001)。鲍氏不动杆菌、肺炎克雷伯菌、阴沟肠杆菌和屎肠球菌的耐药性尤为明显,对常用抗菌药物的总体耐药率分别达68.1%、60.5%、59.8%和59.4%。鲍氏不动杆菌耐药率居前三的抗菌药物为哌拉西林、磺胺甲噁唑/甲氧苄啶和头孢噻肟,肺炎克雷伯菌耐药率居前三的抗菌药物为哌拉西林、头孢曲松和头孢噻肟,阴沟肠杆菌耐药率居前三的抗菌药物为头孢西丁、氨卞西林/舒巴坦和头孢呋辛,屎肠球菌耐药率居前三的抗菌药物为青霉素G、氨卞西林和红霉素。脑脊液来源的大肠埃希菌、阴沟肠杆菌、鲍氏不动杆菌和屎肠球菌对喹诺酮类耐药性较高,肺炎克雷伯菌、铜绿假单胞菌及粪肠球菌则较低。结论 Mohnarin不同标本分离的病原菌对抗菌药物的耐药性存在显著差异,脑脊液来源的常见细菌均表现为多重耐药,且耐药性明显高于血液与胆汁来源的菌株。Objective To compare and analyze the differences of bacterial resistance of 3 different strains of bacteria isolated from Mohnarin cerebrospinal fluid （CSF）, blood and bile of literature published in China, to provide the basis for clinical rational drug use. Methods We searched databases including CNKI and WanFang Data for reports about bacterial resistance from Mohnarin CSF, blood and bile from 2006 to 2014. Two reviewers independently screened literature, extracted data, and analyzed the differences of bacterial resistance from CSF, blood and bile by SPSS 19.0 software. Results Composition ratio of the gram positive bacteria from CSF specimens was much higher than those of the blood and the bile （X2=383.118, P〈0.001）. The separation of E. coli, K. pneurnoniae, E. cloacae, P. aeruginosa, A. baumannii, E. faecium and E. faecalis from CSF exhibited multi-drug resistance, and their resistance rates to commonly used antimicrobial agents were significantly higher than those from blood and bile （P〈0.001）, especially the A. baurnannii, K. pneurnoniae, E. cloacae and E. faeciu, and their overall resistance rates to commonly used antimicrobial drugs were 68.1%, 60.5%, 59.8%, and 59.4%, respectively. The top three antibiotics with higher resistance rate were piperacillin, sulfamethoxazole/trimethoprim and cefotaxime in A. baumannii, piperacillin, ceftriaxone and cefotaxime in K. pneurnoniae, cefoxitin, Ampicillin/sulbactam and cefuroxime in E. cloacae, penicillin G, ampicillin and erythromycin in E. faecium. The resistant rates of quinolone in E. coli, E. cloacae, A. baurnannii and E. faeciurn from CSF specimens werehigh, but low in K. pneumoniae, P. aeruginosa and E. faecalis. Conclusion There are differences for drug resistance of the bacteria from different specimens from Mohnarin~ the bacteria from CSF specimens exhibits multi-drug resistance, the resistances are significantly higher than those from blood and bile.

关 键 词：抗菌药物 耐药性 脑脊液 血液 胆汁 卫生部全国细菌耐药监测网 

分 类 号：R446.5[医药卫生—诊断学]