2005-2007年北京地区三甲医院急诊感染患者的细菌分布、药敏变迁及临床特点分析
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摘要
目的:探讨北京市三甲医院急诊科感染患者的病原菌的分布、流行趋势、药敏状况及抗生素药敏变迁规律;分析急诊科感染患者的临床特点,探讨其细菌分布、药敏状况等与医院感染的区别,并研究感染严重度的临床危险因素及炎性指标、凝血指标变化等内容。
方法:选择北京市5家大型三甲医院,收集其2005年至2007年急诊科送检进行细菌培养的患者3536例次,对其培养资料进行回顾性分析。资料内容包括患者细菌培养鉴定号、姓名、年龄、性别、标本编号、标本种类、培养细菌种类、常见抗生素药敏结果等。重点分析各家医院送检标本分布情况及构成比、感染细菌前几位菌株种类及感染率变化等;然后综合几家医院的药敏情况,选择最常见的3种细菌(鲍曼不动杆菌、铜绿假单孢菌和金黄色葡萄球菌)为代表,分析3年来常见抗生素的敏感率及敏感率变迁。选择解放军总医院2007年急诊科送检细菌培养的患者,分析其临床资料并与解放军总医院呼吸科对比,分析二者细菌培养资料和临床资料的区别。主要内容包括两科患者的一般情况、住院时间、疾病谱构成、临床治疗效果、感染细菌种类、抗生素使用情况、主要细菌分布及其对抗生素的药敏变化等方面。对急渗科患者临床资料应用多元回归分析,探讨引起急诊感染细菌种类增加、使用抗生素种类增加的相关危险因素;并对不同感染患者的APACHEⅡ评分、炎性指标CPR和凝血指标进行对比研究。
结果:1、北京市大型三甲医院急诊科2005—2007年感染患者的细菌分布和药敏变迁有以下特点:(1)急诊科感染患者培养标本主要为痰、血液、尿、伤口分泌物和腹水,其中痰、血液和尿标本占总量的分别占总量的67%、16%、10%。3年来,痰、血液标本的采取量出现了较快的升高趋势。(2)急诊科培养的细菌谱表现出医院感染的特点,检出前几位的细菌分别为铜绿假单孢菌、金黄色葡萄球菌、大肠埃希菌、鲍曼不动杆菌和肺炎克雷伯菌。而社区感染常见的细菌如肺炎链球菌、流感嗜血杆菌和肺炎克雷伯菌的检出率非常低。(3)近3年来,细菌的抗生素药敏出现明显下降的趋势,尤其以常用抗生素如头孢类、碳青酶烯类和喹诺酮类显著,抗生素耐药形势不容乐观。(4)目前鲍曼不动杆菌仍以碳青酶烯类敏感为主,其他药物敏感率菌不高,但碳青酶烯类的敏感率在下降;铜绿假单孢菌对碳青酶烯类、加酶青霉素类敏感性较高,近年敏感率也出现显著下降;金黄色葡萄球菌敏感药物很少,目前以万古霉素为主,依然保持100%敏感,其他不甚敏感的抗生素药敏也有下降。2、通过与呼吸科感染患者比较,2007年解放军总医院急诊科感染有以下临床特点:(1)急诊科感染患者的疾病谱与呼吸科有很大的区别,但肺部感染/COPD患者的比重在两个科室都占第一位。(2)急诊科感染患者住院时间要短于呼吸科,且抗生素使用的数量要少于呼吸科。(3)急诊科感染主要细菌与呼吸科相似,前5位分别为鲍曼不动杆菌、铜绿假单孢菌、大肠埃希菌、金黄色葡萄球菌和凝固酶阴性葡萄球菌。(4)同样的细菌,两个科室的药敏却相差显著。其中常见抗生素对鲍曼不动杆菌的敏感率呼吸科多数要优于急诊科,对铜绿假单孢菌的敏感率急诊科多数要优于呼吸科,而对金黄色葡萄球菌的敏感率两个科室相近,急诊科总体上略优于呼吸科。(5)急诊科感染细菌种数的增加与患者住院时间长短、是否气管插管、使用抗生素数目明显相关(p≤0.05);同时,使用抗生素数量的多少与患者感染细菌数目、住院时间长短显著相关(p≤0.05)。(6)随着感染细菌种类的增多,特别是感染细菌超过3种时,患者CPR呈现显著升高(p≤0.05)。(7)患者感染细菌数目增加,其凝血指标也发生较大变化,主要表现为向高凝状念发展。
结论:北京市大型三甲医院急诊感染患者病原学上更多表现出医院感染的特征,但其药敏情况与医院感染患者又不完全相同。总体而言,3年来急诊感染的细菌药敏出现了较大的下降,包括常见高效的抗生素在内。急诊感染程度的加重与住院时间、抗生素使用、气管插管等有创操作有关;随着感染的加重,患者凝血系统呈现高凝的趋势;血清CPR指标一定程度上可以反映感染的严重程度。
Objective: To investigate changes of antibiotics sensitivity of emergency infections in Beijing large hospitals from 2005 to 2007, and study their clinical features including the bacterias distribution, antibiotics sensitivity changes, infection risk factors, infection indicators and blood coagulation changes, et al. Methods: Altogether there were 3536 strains were cultrued in recent three years. All the data such as type of spicemen, bacterium strain identification, antibiotics sensitivity and so on were investigated respectively. Two departments(emergency department and respiratory department) in PLA general hospital were studied with their clinical featrues in 2007. We investigated patients' hospitalized time, diseases classfication, effect of treatment, strain isolation, antibiotics sensitevity, invasive therapies, high risk factors, APACHE II evaluations, C-reaction protein level and the blood coagulation index and so on. Results: 1. The bacteria distribution and their sensitivity to antibiotics in emergency departments displayed the following charactristics: (1) Sputum, blood and urine were the three main specimen in emergency department. (2) The main bacteria been cultured were P.aeruginosa, S. aureus, E. coli, A. baumannii, and K. pneumoniae, which were similar to the hospital infection. On the contrary, commom bacteria of community infection such as S.pneunomiae and H. influenza were relatively rare. (3) The sensitivity of common antibiotics decreased grately in the recent three years, especially Carbapenems, cephlosporins and quinolones. 2、The emergency infections in general hospital in 2007 had the following characteristics: (1) Lung infection was the first main infection in the two departments. (2) Infection patients hospitalize time in emergency was shorter than respiratory department, and antibiotics number used also was less than respiratory department. (3) The main bacteria were similar in the two departments, but their antibiotics sensitivities were quite different. (4) The severity of infection in emergency department was significant related to factors such as hospitalized time, tracheal intubation and the number of antibiotics used (p≤0.05). (5) Infection bacterium numbers increasing may raise CPR level and promote blood coagulation activity. Conclusion: Emergency infection bacteria in Beijing large hospital mainly showed hospital infection characteristics, but their antibiotics sensitivity were different to hospital infection. In the recent three years, their sensetivity to antibiotics had dropped greatly. The severity of infection in emergency department is greatly related to antibiotics number they used.
方法:选择北京市5家大型三甲医院,收集其2005年至2007年急诊科送检进行细菌培养的患者3536例次,对其培养资料进行回顾性分析。资料内容包括患者细菌培养鉴定号、姓名、年龄、性别、标本编号、标本种类、培养细菌种类、常见抗生素药敏结果等。重点分析各家医院送检标本分布情况及构成比、感染细菌前几位菌株种类及感染率变化等;然后综合几家医院的药敏情况,选择最常见的3种细菌(鲍曼不动杆菌、铜绿假单孢菌和金黄色葡萄球菌)为代表,分析3年来常见抗生素的敏感率及敏感率变迁。选择解放军总医院2007年急诊科送检细菌培养的患者,分析其临床资料并与解放军总医院呼吸科对比,分析二者细菌培养资料和临床资料的区别。主要内容包括两科患者的一般情况、住院时间、疾病谱构成、临床治疗效果、感染细菌种类、抗生素使用情况、主要细菌分布及其对抗生素的药敏变化等方面。对急渗科患者临床资料应用多元回归分析,探讨引起急诊感染细菌种类增加、使用抗生素种类增加的相关危险因素;并对不同感染患者的APACHEⅡ评分、炎性指标CPR和凝血指标进行对比研究。
结果:1、北京市大型三甲医院急诊科2005—2007年感染患者的细菌分布和药敏变迁有以下特点:(1)急诊科感染患者培养标本主要为痰、血液、尿、伤口分泌物和腹水,其中痰、血液和尿标本占总量的分别占总量的67%、16%、10%。3年来,痰、血液标本的采取量出现了较快的升高趋势。(2)急诊科培养的细菌谱表现出医院感染的特点,检出前几位的细菌分别为铜绿假单孢菌、金黄色葡萄球菌、大肠埃希菌、鲍曼不动杆菌和肺炎克雷伯菌。而社区感染常见的细菌如肺炎链球菌、流感嗜血杆菌和肺炎克雷伯菌的检出率非常低。(3)近3年来,细菌的抗生素药敏出现明显下降的趋势,尤其以常用抗生素如头孢类、碳青酶烯类和喹诺酮类显著,抗生素耐药形势不容乐观。(4)目前鲍曼不动杆菌仍以碳青酶烯类敏感为主,其他药物敏感率菌不高,但碳青酶烯类的敏感率在下降;铜绿假单孢菌对碳青酶烯类、加酶青霉素类敏感性较高,近年敏感率也出现显著下降;金黄色葡萄球菌敏感药物很少,目前以万古霉素为主,依然保持100%敏感,其他不甚敏感的抗生素药敏也有下降。2、通过与呼吸科感染患者比较,2007年解放军总医院急诊科感染有以下临床特点:(1)急诊科感染患者的疾病谱与呼吸科有很大的区别,但肺部感染/COPD患者的比重在两个科室都占第一位。(2)急诊科感染患者住院时间要短于呼吸科,且抗生素使用的数量要少于呼吸科。(3)急诊科感染主要细菌与呼吸科相似,前5位分别为鲍曼不动杆菌、铜绿假单孢菌、大肠埃希菌、金黄色葡萄球菌和凝固酶阴性葡萄球菌。(4)同样的细菌,两个科室的药敏却相差显著。其中常见抗生素对鲍曼不动杆菌的敏感率呼吸科多数要优于急诊科,对铜绿假单孢菌的敏感率急诊科多数要优于呼吸科,而对金黄色葡萄球菌的敏感率两个科室相近,急诊科总体上略优于呼吸科。(5)急诊科感染细菌种数的增加与患者住院时间长短、是否气管插管、使用抗生素数目明显相关(p≤0.05);同时,使用抗生素数量的多少与患者感染细菌数目、住院时间长短显著相关(p≤0.05)。(6)随着感染细菌种类的增多,特别是感染细菌超过3种时,患者CPR呈现显著升高(p≤0.05)。(7)患者感染细菌数目增加,其凝血指标也发生较大变化,主要表现为向高凝状念发展。
结论:北京市大型三甲医院急诊感染患者病原学上更多表现出医院感染的特征,但其药敏情况与医院感染患者又不完全相同。总体而言,3年来急诊感染的细菌药敏出现了较大的下降,包括常见高效的抗生素在内。急诊感染程度的加重与住院时间、抗生素使用、气管插管等有创操作有关;随着感染的加重,患者凝血系统呈现高凝的趋势;血清CPR指标一定程度上可以反映感染的严重程度。
Objective: To investigate changes of antibiotics sensitivity of emergency infections in Beijing large hospitals from 2005 to 2007, and study their clinical features including the bacterias distribution, antibiotics sensitivity changes, infection risk factors, infection indicators and blood coagulation changes, et al. Methods: Altogether there were 3536 strains were cultrued in recent three years. All the data such as type of spicemen, bacterium strain identification, antibiotics sensitivity and so on were investigated respectively. Two departments(emergency department and respiratory department) in PLA general hospital were studied with their clinical featrues in 2007. We investigated patients' hospitalized time, diseases classfication, effect of treatment, strain isolation, antibiotics sensitevity, invasive therapies, high risk factors, APACHE II evaluations, C-reaction protein level and the blood coagulation index and so on. Results: 1. The bacteria distribution and their sensitivity to antibiotics in emergency departments displayed the following charactristics: (1) Sputum, blood and urine were the three main specimen in emergency department. (2) The main bacteria been cultured were P.aeruginosa, S. aureus, E. coli, A. baumannii, and K. pneumoniae, which were similar to the hospital infection. On the contrary, commom bacteria of community infection such as S.pneunomiae and H. influenza were relatively rare. (3) The sensitivity of common antibiotics decreased grately in the recent three years, especially Carbapenems, cephlosporins and quinolones. 2、The emergency infections in general hospital in 2007 had the following characteristics: (1) Lung infection was the first main infection in the two departments. (2) Infection patients hospitalize time in emergency was shorter than respiratory department, and antibiotics number used also was less than respiratory department. (3) The main bacteria were similar in the two departments, but their antibiotics sensitivities were quite different. (4) The severity of infection in emergency department was significant related to factors such as hospitalized time, tracheal intubation and the number of antibiotics used (p≤0.05). (5) Infection bacterium numbers increasing may raise CPR level and promote blood coagulation activity. Conclusion: Emergency infection bacteria in Beijing large hospital mainly showed hospital infection characteristics, but their antibiotics sensitivity were different to hospital infection. In the recent three years, their sensetivity to antibiotics had dropped greatly. The severity of infection in emergency department is greatly related to antibiotics number they used.
引文
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33、Rintala E,Remes K,Salmi TT,et al.The effects of Pretransplant Conditioning,Graft-versus-host Disease and Sepsis on the CRP Levels in Bone Marrow Transplantation[J].Infection,1997,25:335-338.
34、Mat son A,Soni N,Sheldon J.C-reactive Protein as a Diagnostic Test of Sepsis in the Critically Ill[J].Anaesth Intensive Care,1991,19:182-186.
35、朱惠莉,龚瑾,符礼刚,等.肺部感染时凝血和纤溶系统的变化.中国危重病急救医学,2003,15(3):180-181.
36、Bernard GR,Vincent JL,Laterre PF,et al.Efficacy and safety of recombinant human activated protein C for severe sepsis.New Eng J Med,2001,344(10):699-709.
37、刘贵健,王宝恩,张永宏,等.急症感染并发多系统脏器功能衰竭时凝血和纤溶系统变化的研究.中华内科杂志,1996,35(10):673-677.
38、Abraham E.Coagulation abnormalities in acute lung injury and sepsis.Am J Respir Cell Mol Biol,2000,22(4):412-421.
1、文细毛,任南,徐秀华,等.全国ICU感染监控网ICU感染病原菌分布及耐药性分析[J].中华ICU感染学杂志,2002,12(4):241-244.
2、Magalhaes M,Doherty C,Govan JR,et al.Polyclonal outbreak of burkholderia cepacia complex bacteria in hemodialysis patients[J].J Hosp Infect,2006,54(20):120-123.
3、王力红,石海鸥,张京利.重症监护患者ICU感染前瞻性研究[J].中华ICU感染学杂志,2002,12(4):268-270.
4、KollefMH.Optimizing antibiotic therapy in the intensive care unit setting[J].Crit Care,2001,5(4):189-195.
5、Traub J F,Coelho J M,KaufmannM E,et al.Detection and typing of integrons in epidemic strains of Acinetobacter baumannii found in the United Kingdom[J].J Clin Microbiol,2005,43(7):3074-3082.
6、蓝如束,赵丽,廖光付.重症监护室感染菌群分析及控制感染对策[J].中华ICU感染学杂志,2002,12(4):284-285.
7、Tatman—Otkun M,Gurcan S,Ozer B,et al.Annual trends inantibiotic resistance of nosocomial Acinetobacter baumannii strains and the effect of synergistic antibiotic combinations[J].New Microbiol,2004,27(1):21-28.
8、王辉,孙宏莉,廖康,等.北京和广州地区四家医院不动杆菌碳青霉烯酶基因型研究[J].中华检验医学杂志,2005,28(6):636-641.
9、磨国鑫,佘丹阳,陈良安.呼吸机相关性肺炎病原菌分布特点及变迁[J].中华医院感染学杂志,2006,16(4):457-459.
10、罗燕萍,沈定霞,张有江,等.我院1995～1999年细菌流行分布及耐药监测[J].中华医院感染学杂志,2006,16(2):212-215.
11、王辉,陈民钧.1994～2001年中国重症监护病房非发酵糖细菌的耐药变迁[J].中华医学杂志,2003,83(5):385-390.
12、洪锦兰.连续5年住院患者医院感染病例检测分析[J].赣州医学院学报,2007,27(4):617-619.
13、吴安华,任南,文细毛,等.全国医院感染监控网1998～1999年监测资料分析[J].中华医院感染学杂志,2000,10(6):401-403.
14、王红旗,徐燕,刘莲香.369例医院感染病例调查分析[J].中华医院感染学杂志,2005,15(5):515-516.
15、李玥.2003～2006年我院临床分离非发酵菌耐药性分析[J].中国医药导报,2007,4(33):83-84.
16、仲兆舍.氟喹诺酮类药物在眼科治疗中心的应用[J].国外医学抗生素分册,2002,23(5):230-235.
17、糜祖煌.细菌耐药的分子机制[J].临床儿科杂志,2005,23(7):422-424.
18、Moosdeen F.The evolution of resistace to cephalosporins[J].Clin Infect Dis,1997,24:487-493.
19、Livermore DM.Beta—lactamase mediated resistance and opportunities for its control[J].Antimicrob Chemother,1998,41(Suppl D):25-41.
20、Ambler RP.The structure of bata-lactamases[J].Philosophical Transactions of the Royal Society of London,Series B.Biological Sciences,1980,289:321-331.
21、Garan J.The clinical impact of macrolide resistance in pneumococcal respiratory infections[J].Antimicrob Agents,2001,18(Suppl 1):S33-S38.
22、王睿,柴栋.细菌耐药机制与临床治疗对策[J].国外医药抗生素分册,2003,24(3):97-103.
23、吴迪,陈升汶.铜绿假单胞菌对碳青霉烯耐药机制的研究[J].国际呼吸杂志,2007,27(8):610-612.
24、Costerton JW,Stewart PS,Greenberg EP,et al.Bacterial biofilms:a common cause of persistent infections[J].Science,1999,284:1318-1322.
25、彭青,钱元恕.细菌生物被膜及其相关感染的研究进展[J].中国抗感染化疗杂志,2004,4(2):126-128.
26、刘小琰,施安国.细菌生物被膜的研究现状[J].中国临床药理学杂志,2002,18(4):302-305.
27、徐英春,陈民钧.AmpC酶与革兰阴性菌的耐药特征[J].中华微生物学和免疫学杂志,2001,21(suppl):14-16.
28、蒋燕群.质粒AmpC β-内酰胺酶及其多聚合酶链反应检测[J].国外医学微生物分册,2003,26(1):33.
29、Philippon Arlet G,Jacoby GA.Antimicrob Agent chemther,2002,46(1):74-78.
30、Medeiros A.Evolution and dissemination of β-lactamases accelerated by generation of β-lactam antibiotics[J].Clin infect Dis,2001,24:19-45.
31、Philippon Arlet G,Jacoby GA.Plasmid-determined AmpC type β-lactamases [J].Minireview,2001,1:23.
32、金少鸿,张凤凯,编译.抗生素耐药性现状透视[J].国外医学药学分册,2000,27(2):74-78.
33、Tsakris A,Pantazi A,Ponmaras S,et al.Psendo-outbreak of Imipenem -resistant A.baniannii resenting form faese susceptibility testing by a rapid rantomated system[J].J Clin Microbiol,2000,38(9):3505-3507.
34、刘小琰,施安国.细菌生物被膜的研究现状[J].中国临床药理学杂志,2002,18(4):302-305.
35、李继安,陈代杰.细菌耐药性的研究与新药开发Ⅱ药物作用靶位被修饰或发生突变的耐药机制与新药研究[J].国外医学合成药纯化药制剂分册,2001,22(3):132-133,136.
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[5]董卫,赵海军,吴王杲等.大肠埃希氏菌和肺炎克类伯杆菌感染病人ESBLs 的检测及而药性分析[J].世界感染学杂志,2006,6(1):61-63.
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2、王力红,石海鸥,张京利.重症监护患者ICU感染前瞻性研究[J].中华ICU 感染学杂志,2002,12(4):268-270.
3、KollefMH.Optimizing antibiotic therapy in the intensive care unit setting[J].Crit Care,2001,5(4):189-195.
4、Traub J F,Coelho J M,KaufmannM E,et al.Detection and typing of integrons in epidemic strains of Acinetobacter baumannii found in the United Kingdom[J].J Clin Microbiol,2005,43(7):3074-3082.
5、罗燕萍,沈定霞,张有江,等.我院1995～1999年细菌流行分布及耐药监测.中华医院感染学杂志,2006,16(2):212-215.
6、吴安华,任南,文细毛,等.全国医院感染监控网1998～1999年监测资料分析[J].中华医院感染学杂志,2000,10(6):401-403.
7、蓝如束,赵丽,廖光付。重症监护室感染菌群分析及控制感染对策[J].中华ICU感染学杂志,2002,12(4):284-285.
8、黄海辉,吴菊芳.成人社区获得性肺炎的病原诊治进展.中国感染与化疗杂志.2007,7(4):304-308.
9、磨国鑫,佘丹阳,陈良安.呼吸机相关性肺炎病原菌分布特点及变迁[J].中华医院感染学杂志,2006,16(4):457-459.
10、Tatman—Otkun M,Gurcan S,Ozer B,et al.Annual trends in antibiotic resistance of nosocomial Acinetobacter baumannii strains and the effect of synergistic antibiotic combinations[J].New Microbiol,2004,27(1):21-28.
11、王辉,陈民钧.1994～2001年中国重症监护病房非发酵糖细菌的耐药变迁.中 华医学杂志,2003,83(5):385-390.
12、李华,濮跃晨,戴媛媛.744株鲍曼不动杆菌的耐药性分析.临床输血与检验.2007,9(4):363-364.
13、张哲,蒋晓飞,吕元.鲍氏不动杆菌耐药性与β2内酰胺酶基因型研究.中华医院感染学杂志,2007,17(10):1189-1192.
14、李学如,孟涛,王艳,等.铜绿假单胞菌耐药机理研究进展[J].国外医药抗菌药物分册,2004,25(3):105-108.
15、蒋景华,陈文光,章泽豹,等.金黄色葡萄球菌耐药的现状及临床治疗对策.中华医院感染学杂志,2007,17(10):1292-1293.
16、李继安,陈代杰.细菌耐药性的研究与新药开发Ⅱ药物作用靶位被修饰或发生突变的耐药机制与新药研究[J].国外医学合成药纯化药制剂分册,2001,22(3):132-133,136.
17、Fry AM,Shay DK,Holman RC,et al.Trends in hospitalizations for pneumonia among persons aged 65 years or older in the United States,1988-2002[J].JAMA,2005,294(21):2712-2719.
18、孙铁英,刘兵,扬敏.社区获得性肺炎老年住院患者的临床分析[J].中华老年医学杂志,2005,24(2):100-105.
19、Diaz A,Barria P,Niederman M,et al.Etiology of community-acquired pneumonia in hospitalized patients in chile:the increasing prevalence of respiratory viruses among classic pathogens[J].Chest,2007,131(3):779-787.
20、Ngeow YF,Suwanjut ha S,Chantarojanasriri T,et al.An Asian study on the prevalence of atypical respiratory pathogens in community-acquired pneumonia[J].Intern J Infect Dis,2005,9(3):144-153.
21、Miyashita N,Fukano H,Mouri K,et al.Community-acquired pneumonia in Japan:a prospective ambulatory and hospitalized patients study[J].J Med Microbiol,2005,54(4):395-400.
22、魏丽,胡必杰,何礼贤,等.中国城市成人社区获得性肺炎病原谱和预后的流行病学调查[C].上海:第六届全国感染性疾病及抗微生物化疗学术会议, 2005.
23、刘又宁,陈民钧,赵铁梅,等.中国城市成人社区获得性肺炎665例病原学多中心调查[J].中华结核和呼吸杂志,2006,29(1):3-8.
24、蔡少华.呼吸机相关性肺炎的抗生素治疗及及失败原因分析[J].国外医学.抗生素分册,2002,23(6):241-245.
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27、王力红,马文晖,张京利,等.APACHE Ⅱ评分与医院感染相关性研究.中华医院感染学杂志 2007,17(6):651-653.
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31、Peres BotaD,Melot C,Lopes Ferreira F,et al.Infection Probability Score(IPS):a Method to Help Assess the Probability of Infection in Critically ill Patients[J].Crit Care Med,2003,31:2579-2584.
32、Sierra R,Rello J,Bailen M A,et al.Pedraza S:Creactive Protein Used as an Early Indicator of Infection in Patients with Systemic Inflammatory Response Syndrome[J].Intensive Care Med,2004,30:2038-2045.
33、Rintala E,Remes K,Salmi TT,et al.The effects of Pretransplant Conditioning,Graft-versus-host Disease and Sepsis on the CRP Levels in Bone Marrow Transplantation[J].Infection,1997,25:335-338.
34、Mat son A,Soni N,Sheldon J.C-reactive Protein as a Diagnostic Test of Sepsis in the Critically Ill[J].Anaesth Intensive Care,1991,19:182-186.
35、朱惠莉,龚瑾,符礼刚,等.肺部感染时凝血和纤溶系统的变化.中国危重病急救医学,2003,15(3):180-181.
36、Bernard GR,Vincent JL,Laterre PF,et al.Efficacy and safety of recombinant human activated protein C for severe sepsis.New Eng J Med,2001,344(10):699-709.
37、刘贵健,王宝恩,张永宏,等.急症感染并发多系统脏器功能衰竭时凝血和纤溶系统变化的研究.中华内科杂志,1996,35(10):673-677.
38、Abraham E.Coagulation abnormalities in acute lung injury and sepsis.Am J Respir Cell Mol Biol,2000,22(4):412-421.
1、文细毛,任南,徐秀华,等.全国ICU感染监控网ICU感染病原菌分布及耐药性分析[J].中华ICU感染学杂志,2002,12(4):241-244.
2、Magalhaes M,Doherty C,Govan JR,et al.Polyclonal outbreak of burkholderia cepacia complex bacteria in hemodialysis patients[J].J Hosp Infect,2006,54(20):120-123.
3、王力红,石海鸥,张京利.重症监护患者ICU感染前瞻性研究[J].中华ICU感染学杂志,2002,12(4):268-270.
4、KollefMH.Optimizing antibiotic therapy in the intensive care unit setting[J].Crit Care,2001,5(4):189-195.
5、Traub J F,Coelho J M,KaufmannM E,et al.Detection and typing of integrons in epidemic strains of Acinetobacter baumannii found in the United Kingdom[J].J Clin Microbiol,2005,43(7):3074-3082.
6、蓝如束,赵丽,廖光付.重症监护室感染菌群分析及控制感染对策[J].中华ICU感染学杂志,2002,12(4):284-285.
7、Tatman—Otkun M,Gurcan S,Ozer B,et al.Annual trends inantibiotic resistance of nosocomial Acinetobacter baumannii strains and the effect of synergistic antibiotic combinations[J].New Microbiol,2004,27(1):21-28.
8、王辉,孙宏莉,廖康,等.北京和广州地区四家医院不动杆菌碳青霉烯酶基因型研究[J].中华检验医学杂志,2005,28(6):636-641.
9、磨国鑫,佘丹阳,陈良安.呼吸机相关性肺炎病原菌分布特点及变迁[J].中华医院感染学杂志,2006,16(4):457-459.
10、罗燕萍,沈定霞,张有江,等.我院1995～1999年细菌流行分布及耐药监测[J].中华医院感染学杂志,2006,16(2):212-215.
11、王辉,陈民钧.1994～2001年中国重症监护病房非发酵糖细菌的耐药变迁[J].中华医学杂志,2003,83(5):385-390.
12、洪锦兰.连续5年住院患者医院感染病例检测分析[J].赣州医学院学报,2007,27(4):617-619.
13、吴安华,任南,文细毛,等.全国医院感染监控网1998～1999年监测资料分析[J].中华医院感染学杂志,2000,10(6):401-403.
14、王红旗,徐燕,刘莲香.369例医院感染病例调查分析[J].中华医院感染学杂志,2005,15(5):515-516.
15、李玥.2003～2006年我院临床分离非发酵菌耐药性分析[J].中国医药导报,2007,4(33):83-84.
16、仲兆舍.氟喹诺酮类药物在眼科治疗中心的应用[J].国外医学抗生素分册,2002,23(5):230-235.
17、糜祖煌.细菌耐药的分子机制[J].临床儿科杂志,2005,23(7):422-424.
18、Moosdeen F.The evolution of resistace to cephalosporins[J].Clin Infect Dis,1997,24:487-493.
19、Livermore DM.Beta—lactamase mediated resistance and opportunities for its control[J].Antimicrob Chemother,1998,41(Suppl D):25-41.
20、Ambler RP.The structure of bata-lactamases[J].Philosophical Transactions of the Royal Society of London,Series B.Biological Sciences,1980,289:321-331.
21、Garan J.The clinical impact of macrolide resistance in pneumococcal respiratory infections[J].Antimicrob Agents,2001,18(Suppl 1):S33-S38.
22、王睿,柴栋.细菌耐药机制与临床治疗对策[J].国外医药抗生素分册,2003,24(3):97-103.
23、吴迪,陈升汶.铜绿假单胞菌对碳青霉烯耐药机制的研究[J].国际呼吸杂志,2007,27(8):610-612.
24、Costerton JW,Stewart PS,Greenberg EP,et al.Bacterial biofilms:a common cause of persistent infections[J].Science,1999,284:1318-1322.
25、彭青,钱元恕.细菌生物被膜及其相关感染的研究进展[J].中国抗感染化疗杂志,2004,4(2):126-128.
26、刘小琰,施安国.细菌生物被膜的研究现状[J].中国临床药理学杂志,2002,18(4):302-305.
27、徐英春,陈民钧.AmpC酶与革兰阴性菌的耐药特征[J].中华微生物学和免疫学杂志,2001,21(suppl):14-16.
28、蒋燕群.质粒AmpC β-内酰胺酶及其多聚合酶链反应检测[J].国外医学微生物分册,2003,26(1):33.
29、Philippon Arlet G,Jacoby GA.Antimicrob Agent chemther,2002,46(1):74-78.
30、Medeiros A.Evolution and dissemination of β-lactamases accelerated by generation of β-lactam antibiotics[J].Clin infect Dis,2001,24:19-45.
31、Philippon Arlet G,Jacoby GA.Plasmid-determined AmpC type β-lactamases [J].Minireview,2001,1:23.
32、金少鸿,张凤凯,编译.抗生素耐药性现状透视[J].国外医学药学分册,2000,27(2):74-78.
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