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Epidemiology and antimicrobial resistance of Acinetobacter 不动杆菌的流行病学及耐药性研究
Pub Date : 2018-12-27 DOI: 10.31405/IJAP.4-5.18.05
A. Salmanov, O. M. Verner, L. F. Slepova
Species of the Acinetobacter represent opportunistic bacteria with a growing clinical significance for Healthcare-associated infections (HAIs). In this literature review, we focus on the current role of Acinetobacter in infectious pathology and describe taxonomy, pathogenicity, and antibiotic resistance of these bacteria. Pathogenesis and regulation of virulence factors in Acinetobacter spp. are described in detail. The majority of acinetobacterial infections are associated with A. baumannii and occur predominantly in an immunocompromised host. Usually, acinetobacterial  infections  are characterized by local purulent inflammation; in severe cases, meningitis and sepsis may develop. Antibiotic resistance of Acinetobacter is a major clinical problem; therefore we give special attention to laboratory testing of resistance to antibiotics as well as identification of Acinetobacter.
不动杆菌的种类代表了机会性细菌,在医疗保健相关感染(HAIs)中具有越来越重要的临床意义。在这篇文献综述中,我们重点介绍了不动杆菌在感染病理学中的作用,并描述了这些细菌的分类、致病性和抗生素耐药性。本文对不动杆菌的致病机制和毒力因子的调控作了详细的描述。大多数不动杆菌感染与鲍曼不动杆菌有关,主要发生在免疫功能低下的宿主中。通常,不动杆菌感染的特征是局部化脓性炎症;严重者可发展为脑膜炎和败血症。不动杆菌的抗生素耐药是一个重大的临床问题;因此,我们特别关注抗生素耐药性的实验室检测以及不动杆菌的鉴定。
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引用次数: 2
Antimicrobial Resistance is a Global Problem 抗菌素耐药性是一个全球性问题
Pub Date : 2018-12-27 DOI: 10.31405/IJAP.4-5.18.01
A. Salmanov, V. Trokhymchuk, O. M. Verner, O. Lugach
Infectious agents resistance to antimicrobials remains a challenging open problem of health care around the world. As a result, treatment-induced infections pose a serious threat to public health in general. This problem has become so important that the overwhelming majority of countries consider it a threat to the national security. Resistance to antimicrobials threatens to offset the very fundamentals of modern medicine and the sustainability of the public health system effective global response to a permanent infectious diseases threat. Today, antimicrobial resistance issues can be tackled provided that one implements an effective One Health approach (the principle of human and animal health interrelation), assuming that there is a coordination between different sectors and subjects, including experts in medicine, veterinary medicine, agriculture, ecology, and well-informed consumers. To ensure effectiveness of treatment, action is urgently needed to counteract the further development and spread of antibiotic resistance, which is driven by antibiotic use in all sectors. Since this resistance has no ecological, sectoral or geographical borders, its appearance in one sector affects resistance in other sectors. National authorities, veterinarians, physicians, patients and farmers all have key roles in preserving the power of antibiotics. The prevention and containment of antibiotic resistance therefore requires addressing all risk factors for the development and spread of antibiotic resistance across the full spectrum of conditions, sectors, settings (from health care to use in food-animal production) and countries. This article explores the options for prevention and containment of antibiotic resistance in the food-chain through national coordination, including the regulation and reduction of antibiotic use in food animals, training and capacity building, surveillance of resistance trends and antibiotic usage, promotion of knowledge and research, and advocacy and communication to raise awareness of the issues. The article suggests possible ways for adopting a holistic, intersectoral, multifaceted approach to this growing problem.
传染性病原体对抗菌素的耐药性仍然是世界各地卫生保健的一个具有挑战性的开放性问题。因此,治疗引起的感染对一般公众健康构成严重威胁。这个问题已经变得如此重要,以至于绝大多数国家都认为它是对国家安全的威胁。对抗微生物药物的耐药性有可能抵消现代医学的根本基础和公共卫生系统的可持续性,即对永久性传染病威胁的有效全球应对。今天,只要实施有效的“同一个健康”方针(人类和动物健康相互关系的原则),假设不同部门和主体,包括医学、兽医学、农业、生态学专家和知情的消费者之间进行协调,就可以解决抗菌素耐药性问题。为了确保治疗的有效性,迫切需要采取行动,遏制抗生素耐药性的进一步发展和传播,这是由所有部门使用抗生素造成的。由于这种耐药性没有生态、部门或地理边界,它在一个部门的出现会影响其他部门的耐药性。国家主管部门、兽医、医生、患者和农民在保持抗生素效力方面都发挥着关键作用。因此,预防和遏制抗生素耐药性需要解决导致抗生素耐药性在各种条件、部门、环境(从卫生保健到食用动物生产中的使用)和国家中产生和传播的所有风险因素。本文探讨了通过国家协调预防和遏制食物链中抗生素耐药性的各种选择,包括监管和减少食用动物的抗生素使用、培训和能力建设、耐药性趋势和抗生素使用监测、促进知识和研究以及宣传和沟通,以提高对这些问题的认识。这篇文章提出了对这一日益严重的问题采取全面、跨部门和多方面办法的可能方法。
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引用次数: 0
Antimicrobial Resistance Nosocomial Strains of Enterobacter spp. in Ukrainian surgical Hospitals: results of multicenter study 乌克兰外科医院肠杆菌耐药医院菌株:多中心研究结果
Pub Date : 2018-12-27 DOI: 10.31405/IJAP.4-5.18.04
A. Salmanov, O. M. Verner
Objective. To determine activity of antimicrobials against Enterobacter spp. isolated from patients hospitalized to surgical departments in different Ukrainian hospitals. Materials and methods. A total of 3991 Enterobacter spp. isolated from patients with surgical site infections in 24 surgical hospitals in 17 Ukrainian regions. The identification and antimicrobial susceptibility of Enterobacter spp. were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby - Bauer antibiotic testing. Interpretative criteria were those suggested by the Clinical and Laboratory Standards Institute (CLSI). Results. The most potent antimicrobials were imipenem, meropenem, cefixime and amikacinum. The high rates of resistance were found to penicillin (46,2%), ampicillin/sulbactam (42,9%), gentamicin (40,4%), ceftazidime (39,4%), ampicillin (38,2%), and cefuroxime (36,3%). Conclusions. (1) Resistance of nosocomial strains of Enterobacter spp. at in patient medical institutions, that are subject to research, is a serious therapeutic and epidemiologic issue. Imipenem, meropenem, cefixime and amikacinum have been the most active to nosocomial strains of Enterobacter spp. (2) Taking into account resent changes and resistance levels of nosocomial strains of Enterobacter spp., which take place in various regions, constant monitoring over resistance to antimicrobials at every in patient medical institution is required. Also, hospital record sheets of antibiotics should be elaborated based upon the local data received. (3) Antibiotics utilization policy in each surgical in patient institution should be determined based in accordance with the local data on resistance to antimicrobials. (4) System of epidemiologic surveillance over antimicrobial resistance should be established on the local, regional, and national level.
目标。目的测定乌克兰不同医院外科住院患者分离的肠杆菌抗菌药物的活性。材料和方法。从乌克兰17个地区24家外科医院手术部位感染患者中共分离出3991株肠杆菌。采用全自动微生物分析仪对肠杆菌进行鉴定和药敏试验。部分药敏试验采用Kirby - Bauer抗生素试验。解释性标准是由临床和实验室标准协会(CLSI)提出的。结果。最有效的抗菌剂是亚胺培南、美罗培南、头孢克肟和阿米卡辛。耐药率最高的是青霉素(46.2%)、氨苄西林/舒巴坦(42.9%)、庆大霉素(40.4%)、头孢他啶(39.4%)、氨苄西林(38.2%)和头孢呋辛(36.3%)。结论。(1)患者医疗机构中肠杆菌医院内菌株的耐药是一个严重的治疗和流行病学问题,是有待研究的课题。亚胺培南、美罗培南、头孢克肟和阿米卡敏对医院内肠杆菌菌株最活跃。(2)考虑到不同地区肠杆菌医院内菌株的最新变化和耐药水平,需要在每个患者医疗机构持续监测对抗菌素的耐药性。此外,应根据收到的当地数据详细编制医院抗生素记录单。(3)根据当地抗菌药物耐药数据,确定各住院医院外科的抗菌药物使用政策。(4)在地方、区域和国家层面建立抗菌药物耐药性流行病学监测体系。
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引用次数: 2
Comparative analysis of the effectiveness of simultaneous laparoscopic operations in acute appendicitis accompanied by various gynecological pathologies 腹腔镜同步手术治疗急性阑尾炎伴多种妇科疾病的疗效比较分析
Pub Date : 2018-12-27 DOI: 10.31405/ijap.4-5.18.03
Asmar Mustafayeva
Introduction. According to the World Health Organization 20 to 30% of gynecological pathologies in women are assosiatedwith surgical pathology and these challenge surgeons and gynecologists to correct these pathologiessimultaneously. The study aimed to evaluation of effectiveness of simultaneous laparoscopic operations in acute appendicitis accompanied by various gynecological pathologies Material and Methods. Total 88 patients were involved in the study. Of these, 55 patients underwent laparoscopic surgery - appendectomy (A control subgroup) and 33 simultan surgeries (core B subgroups). Diagnosis of acute abdomenal in gynecological patients, including diagnostic laparoscopy, was performed on the basis of algorithm. Comparison of arterial pressure, heart rate, intensity of pain and patients' activation period was studied in control and main subgroups during surgery and postoperative period. Results. Comparative analysis has showed that the statistical difference between these parameters in patients with isolated appendectomy and simultaneous surgery is almost inaccurate and simultaneous operation may be adequate, despite the complex effects of some negative factors of laparoscopy.
介绍。根据世界卫生组织的数据,20%至30%的女性妇科病理与外科病理有关,这就要求外科医生和妇科医生同时纠正这些病理。本研究旨在评价腹腔镜同时手术治疗急性阑尾炎伴多种妇科病理的效果。共有88名患者参与了这项研究。其中,55例患者接受了腹腔镜手术-阑尾切除术(A对照组)和33例同时手术(核心B亚组)。基于该算法对妇科急腹症患者进行诊断,包括诊断性腹腔镜检查。比较对照组和主要亚组在手术和术后的动脉压、心率、疼痛强度和患者的激活期。结果。对比分析表明,孤立阑尾切除术患者的这些参数与同期手术的统计差异几乎是不准确的,尽管腹腔镜的一些负面因素影响复杂,但同期手术可能是足够的。
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引用次数: 0
Nosocomial pneumonie in intensive care units: problems and solutions 重症监护病房院内肺炎:问题和解决办法
Pub Date : 2018-12-27 DOI: 10.31405/IJAP.4-5.18.02
A. Salmanov, L. F. Slepova
Nosocomial pneumonia (NP) is a serious problem in healthcare in the world and remains the same, despite the application of new therapies and prevention. Among the infections associated with the provision of healthcare, the state of emergency takes the second - the third place in terms of prevalence and second place in terms of mortality. NP significantly impairs the prognosis of the underlying disease, increases the length of stay of the patient in the hospital and the cost of treatment. Insufficient resolution of issues of prophylaxis, early diagnosis and treatment is the reason that a significant proportion of cases of NP are diagnosed only by the results of autopsy. In recent years, there has been an increase in the number of cases of NP caused by antibiotic-resistant microorganisms, which complicates the implementation of effective empirical antibiotic therapy and disease prevention. The authors propose recommendations that take into account the modern scientific developments of many domestic and foreign researchers on NP issues. The issues of epidemiology, etiology, pathogenesis, clinical classification of the disease are elucidated in detail. Particular attention is paid to surveillance of emergency rooms in intensive care units (ICU).
医院性肺炎(NP)是世界卫生保健中的一个严重问题,尽管应用了新的治疗和预防方法,但仍然如此。在与提供保健有关的感染中,紧急状态排在第二位——在流行率方面排名第三,在死亡率方面排名第二。NP显著损害基础疾病的预后,增加患者在医院的住院时间和治疗费用。预防、早期诊断和治疗问题的解决不足是很大一部分NP病例仅通过尸检结果诊断的原因。近年来,耐药微生物引起的NP病例有所增加,使有效的经验性抗生素治疗和疾病预防的实施复杂化。作者在考虑了许多国内外研究者在NP问题上的现代科学发展的基础上,提出了一些建议。对该病的流行病学、病因学、发病机制、临床分型等问题进行了详细阐述。特别注意对重症监护病房(ICU)急诊室的监测。
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引用次数: 0
ANTIMICROBIAL RESISTANCE IN SEXUALLY TRANSMITTED INFECTIONS 性传播感染中的抗菌素耐药性
Pub Date : 2018-10-06 DOI: 10.31405/IJAP.2-3.18.06
A. Salmanov, I. I. Raksha, N. Dobrianska
Sexually Transmitted Infections (STIs), including gonorrhea, are an actual problem that continues to bother doctors and health care providers. After all, the consequences of urogenital infections are harm to the sexual and reproductive health of the population, to future generations. The level of registration of individual STIs continues to increase, which puts before the health care system and society as a whole the urgent task of preventing the harmful effects of this pathology on public health. In recent years, according to research, the epidemiological characteristics of STIs have changed dramatically. These changes are associated with the expansion of the age and social composition of STI patients. There are changes in the etiology of STIs and the antimicrobial resistance of their pathogens. There are new mechanisms of resistance of STI agents in the most important antibiotics and chemotherapeutic drugs. There is every reason to believe that the problem of antibiotic-resistant strains will continue to exist, which hampers the effectiveness of treatment regimens. Efforts at many levels are important to effectively address this problem, particularly in the areas of new drug development, alternative treatment regimens, and further research on testing antimicrobial resistance.
包括淋病在内的性传播感染(STIs)是一个持续困扰医生和卫生保健提供者的实际问题。毕竟,泌尿生殖系统感染的后果对人口的性健康和生殖健康以及子孙后代都是有害的。个人性传播感染的登记水平继续增加,这使卫生保健系统和整个社会面临防止这种疾病对公共卫生产生有害影响的紧迫任务。近年来,根据研究,性传播感染的流行病学特征发生了巨大变化。这些变化与性传播感染患者年龄和社会构成的扩大有关。性传播感染的病原学及其病原体的抗菌素耐药性发生了变化。在最重要的抗生素和化疗药物中出现了新的性传播感染耐药机制。有充分的理由相信,耐抗生素菌株的问题将继续存在,这阻碍了治疗方案的有效性。许多层面的努力对于有效解决这一问题非常重要,特别是在新药开发、替代治疗方案和进一步研究检测抗菌素耐药性方面。
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引用次数: 0
SURVEILLANCE OF HEALTHCARE-ASSOCIATED INFECTIONS IN UKRAINIAN INTENSIVE CARE UNITS: PROBLEMS AND SOLUTIONS 乌克兰重症监护病房卫生保健相关感染的监测:问题和解决办法
Pub Date : 2018-09-17 DOI: 10.31405/IJAP.2-3.18.02
L. F. Slepova, A. Salmanov
In article modern principles of surveillance of healthcare-associated infections in branches of a Ukrainian intensive care units are submitted. The risk factors influencing occurrence of such infections, ways of prevention of their occurrence and improvement are considered.
在文章中,提出了在乌克兰重症监护病房的分支机构监测保健相关感染的现代原则。探讨了影响此类感染发生的危险因素、预防和改善的方法。
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引用次数: 0
ONE HEALTH: ENVIRONMENTAL CONTAMINATION BY ANTIMICROBIALS 一种健康:抗菌剂对环境的污染
Pub Date : 2018-09-17 DOI: 10.31405/IJAP.2-3.18.05
V. Trokhymchuk, A. Salmanov, O. M. Verner, O. Lugach
Over the past few decades, a high number of pharmaceuticals have been detected in surface, ground and drinking waters. This contamination comes from domestic sewage, livestock, hospitals and chemical- pharmaceutical industries. Typical examples of these pollutants are the antimicrobials – powerful antibiotics used in human and veterinary medicine. The presence of antimicrobials in the environment can pose a serious threat to the ecosystem and to human health due to their high consumption globally. Even at low environmental concentrations, antibiotics stimulate bacterial resistance. The consequences of the presence of fluoroquinolones in the environment are not fully understood, but are known to be toxic to plants and aquatic organisms. Approximately 85% of the antimicrobials present in influents can be removed by conventional wastewater treatment plants, but the removed fraction is frequently accumulated in the sludge, which is sometimes used as fertilizer, representing an additional input route into the environment. The removal of antimicrobials by biological treatment is ineffective, and it is believed that only advanced oxidation technologies are able to destroy these emerging pollutants.
在过去的几十年里,在地表水、地表水和饮用水中发现了大量的药物。这种污染来自生活污水、牲畜、医院和化学制药工业。这些污染物的典型例子是抗菌剂——人类和兽药中使用的强效抗生素。由于抗菌素在全球的高消费量,环境中抗菌素的存在可能对生态系统和人类健康构成严重威胁。即使在低浓度环境下,抗生素也会刺激细菌产生耐药性。氟喹诺酮类药物在环境中存在的后果尚不完全清楚,但已知对植物和水生生物有毒。进水中大约85%的抗菌剂可以通过传统的污水处理厂去除,但去除的部分通常会积聚在污泥中,有时用作肥料,这是进入环境的另一种输入途径。通过生物处理去除抗菌剂是无效的,相信只有先进的氧化技术能够破坏这些新出现的污染物。
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引用次数: 0
Ukrainian Strategy and Action Plan for the Prevention of Healthcare Association Infections (HAIs) and Antimicrobial Resistance 乌克兰预防保健协会感染和抗菌素耐药性战略和行动计划
Pub Date : 2018-09-17 DOI: 10.31405/IJAP.2-3.18.01
A. Salmanov
The Ukrainian Strategy and Action Plan for the Prevention of Healthcare Association Infections (HAIs) and An- timicrobial Resistance defines the purpose, principles and main directions of the improvement of the National system for control and prevention of HAI and AMR pathogens of these infections, mechanisms of its functioning, as well as expected socio-economic impact. Action plan underscores the need for an effective «One Health» approach involving coordination among numer- ous international sectors and actors, including human and veterinary medicine, agriculture, environment, and well-informed consumers. The Action Plan recognizes and addresses both the variable resources nations have to combat antimicrobial resistance. The main objectives of the Ukrainian Action Plan is to improve the regulatory, legal and methodological support system of prevention of Healthcare-associated Infections (HAI), laboratory diagnosis and monitoring of AMR pathogens infections, training system for medical personnel in these fields. We are talking about the introduction of modern approaches and optimization of controls and prevention of HAI, preventing of transmission of multi re- sistance pathogens in healthcare institutions, improving the effectiveness of disinfection and sterilization measures. It is planned to create a unified system of laws and regulations that will ensure effective control and prevention of HAI and AMR, and investigation of outbreaks when they occur and ensuring of adequate compensation to victims; to prepare a standard on infection control with the compliance of mandatory requirements aimed at preventing HAI and AMR in healthcare institutions based on their profile; to create in healthcare institutions the methods of epidemiological diagnostic, based on standard criteria for determining of nosocomial infection cases by anatomic localization of infection. In addition, it is necessary to optimize the list of indications for microbiological and clinical research material and objects of hospital environment, rules of sampling and shipping of samples of biological material in the laboratory. And to develop target prevention programs for HAI and AMR at the national (country), regional and municipal levels. To implement modern technologies on infection control and monitoring of AMR in health care institutions. As a result of the Ukrainian Action Plan is expected to reduce the number of infections caused by resistant strains of microorganism’s mortality, disability and complications from infections associated with medical care, increase the employment potential of the nation by reducing temporary and permanent loss of working ability as a result of population diseases. Also, it is necessary to increase safety of patients and staff while providing medical care.
乌克兰预防保健协会感染和抗生素耐药性战略和行动计划确定了改善控制和预防这些感染的保健协会感染和抗菌素耐药性病原体的国家系统、其运作机制以及预期的社会经济影响的目的、原则和主要方向。《行动计划》强调需要采取有效的"同一个健康"办法,其中涉及许多国际部门和行动者之间的协调,包括人类和兽医、农业、环境和知情的消费者。《行动计划》承认并处理了各国应对抗菌素耐药性的可变资源。乌克兰行动计划的主要目标是改善预防保健相关感染(HAI)的监管、法律和方法支持系统,实验室诊断和监测抗菌素耐药性病原体感染,以及这些领域医务人员的培训系统。我们谈论的是引入现代方法并优化控制和预防HAI,防止医疗机构中多重耐药病原体的传播,提高消毒和灭菌措施的有效性。计划建立一个统一的法律和法规体系,以确保有效控制和预防HAI和AMR,并在发生疫情时进行调查,并确保向受害者提供足够的赔偿;制定一项感染控制标准,符合强制性要求,旨在根据医疗机构的情况预防HAI和抗菌素耐药性;在卫生保健机构中建立流行病学诊断方法,根据通过感染解剖定位确定医院感染病例的标准标准。此外,有必要优化微生物和临床研究材料及医院环境对象的适应症清单、实验室生物材料样品的采样和运输规则。并在国家(国家)、区域和城市各级制定针对HAI和AMR的针对性预防规划。在卫生保健机构实施现代感染控制和抗生素耐药性监测技术。因此,《乌克兰行动计划》预计将减少耐药微生物菌株造成的感染、死亡、残疾和与医疗有关的感染并发症的数量,通过减少因人口疾病而暂时和永久丧失工作能力的人数,增加国家的就业潜力。此外,在提供医疗服务的同时,有必要提高患者和工作人员的安全。
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引用次数: 2
ANTIMICROBIAL RESISTANCE OF PATHOGENS OF HEALTHCARE-ASSOCIATED INFECTIONS IN SURGERY AND INTENSIVE CARE UNITS 外科和重症监护病房中卫生保健相关感染病原菌的抗微生物药物耐药性
Pub Date : 2018-09-17 DOI: 10.31405/IJAP.2-3.18.04
A. Salmanov, L. F. Slepova, O. M. Verner, T. Yarema, P. V. Riabokon
OBJECTIVE. To determine resistance to antibiotics of the pathogens of healthcare-associated infections (HAIs) in surgery and intensive care units in Kyiv hospitals. MATERIALS AND METHODS. The investigation included the analysis of 6159 strains from patients with clinical symptoms HAIs. The identification and antimicrobial susceptibility of cultures were determined, using automated microbiology analyzer Vitek 2 Compact (BioMerieux, France). Susceptibility to antibiotics was determined using AST cards (BioMerieux, France). Some antimicrobial susceptibility test used Kirby – Bauer antibiotic testing. Interpretative criteria were those suggested by the CLSI (USA). RESULTS. The leading agents are E.coli, S.aureus, S.epidermidis, P.aeruginosa, Enterobacter in surgical departments, and Klebsiella, Acinetobacter spp., P.aeruginosa and Enterobacter in departments of intensive care. Multiple resistant hospital cultures are shared in surgical as well as in the departments of intensive care. Its susceptibility to antibiotics was given. CONCLUSIONS. HAIs remain an important cause of morbidity in surgery and intensive care units. Antimicrobial resistance among these and other clinically important pathogens is an increasing problem. The clinical should choose antimicrobial drug in accordance with the local bacterial resistance characteristics for reduce the production of drug resistance and improve the effect of anti-infection treatment possibly.
目标。确定基辅医院外科和重症监护病房中卫生保健相关感染(HAIs)病原体对抗生素的耐药性。材料和方法。调查包括分析来自临床症状HAIs患者的6159株菌株。采用自动微生物分析仪Vitek 2 Compact (BioMerieux, France)检测培养物的鉴定和药敏。使用AST卡(BioMerieux, France)测定抗生素敏感性。部分药敏试验采用Kirby - Bauer抗生素试验。解释性标准是CLSI(美国)建议的标准。结果。外科部门的主要病原体是大肠杆菌、金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌、肠杆菌,重症监护室的主要病原体是克雷伯菌、不动杆菌、铜绿假单胞菌和肠杆菌。多种耐药医院培养在外科和重症监护部门是共享的。观察其对抗生素的敏感性。结论。HAIs仍然是外科和重症监护病房发病的重要原因。这些和其他临床重要病原体之间的抗微生物药物耐药性是一个日益严重的问题。临床应根据局部细菌耐药特点选择抗菌药物,尽可能减少耐药产生,提高抗感染治疗效果。
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引用次数: 1
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International Journal of Antibiotics and Probiotics
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