本文關(guān)鍵詞：ESBL陽(yáng)性的肺炎克雷伯菌和大腸埃希菌對(duì)常用抗生素的耐藥性研究　出處：《山東大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 肺炎克雷伯菌 大腸埃希菌 超廣譜β-內(nèi)酰胺酶 耐藥率

【摘要】：目的：檢測(cè)淄川地區(qū)超廣譜β-內(nèi)酰胺酶(extended spectrum beta lactamase, ESBL)陽(yáng)性的肺炎克雷伯菌和ESBL陽(yáng)性的大腸埃希菌對(duì)常用抗生素的耐藥情況,研究在該地區(qū)常用抗生素對(duì)這兩類細(xì)菌的應(yīng)用前景。方法：收集淄川地區(qū)醫(yī)院自2013年8月至2014年10月分離到的511株肺炎克雷伯菌和403株大腸埃希菌。采用臨床和實(shí)驗(yàn)室標(biāo)準(zhǔn)化研究所(CLSI)推薦的ESBL表型確證試驗(yàn)方法檢測(cè)ESBL,用肉湯微量稀釋法檢測(cè)常用抗生素的最小抑菌濃度(minimum inhibition concentration, MIC)值。判斷藥敏結(jié)果采用CLSI(Clinical and Laboratory Standards Institute)2012年M100-S22標(biāo)準(zhǔn)。運(yùn)用Whonet軟件對(duì)檢測(cè)資料進(jìn)行統(tǒng)計(jì),并用X2檢驗(yàn)對(duì)ESBL日性的肺炎克雷伯菌和ESBL陰性的肺炎克雷伯菌以及ESBL陽(yáng)性的大腸埃希氏菌和ESBL陰性的大腸埃希氏菌對(duì)常用抗生素的耐藥率進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果：肺炎克雷伯菌共有511株,ESBL陽(yáng)性的肺炎克雷伯菌有151株,陽(yáng)性率為29.55%,對(duì)常用抗生素的耐藥率依次為頭孢曲松96.69%、阿莫西林／克拉維酸32.45%、頭孢西丁17.88%、環(huán)丙沙星31.79%、頭孢吡肟17.22%、頭孢唑林100.00%、慶大霉素64.24%、亞胺培南0%,ESBL陰性的肺炎克雷伯菌有360株,對(duì)常用抗生素的耐藥率依次為頭孢曲松7.78%、阿莫西林／克拉維酸9.44%、頭孢西丁10.00%、環(huán)丙沙星8.61%、頭孢吡肟3.33%、頭孢唑林13.61%、慶大霉素6.39%、亞胺培南0%。大腸埃希氏菌共有403,ESBL陽(yáng)性的大腸埃希菌262株,陽(yáng)性率為65.01%,對(duì)常用抗生素的耐藥率依次為頭孢曲松99.24%、環(huán)丙沙星87.79%、頭孢吡肟50.76%、頭孢西丁38.55%、阿莫西林／克拉維酸27.48%、頭孢唑林100.00%、慶大霉素56.49%、亞胺培南0%,ESBL陰性的大腸埃希氏菌有141株,對(duì)常用抗生素的耐藥率依次為頭孢曲松12.06%、環(huán)丙沙星45.39%、頭孢吡肟2.13%、頭孢西丁15.60%、阿莫西林／克拉維酸18.44%、頭孢唑林21.99%、慶大霉素39.01%、亞胺培南0%。除亞胺培南外,其他抗生素經(jīng)過統(tǒng)計(jì)學(xué)X2檢驗(yàn)分析得出：ESBL陽(yáng)性的肺炎克雷伯菌對(duì)常用抗生素耐藥率明顯高于ESBL陰性的肺炎克雷伯菌對(duì)常用抗生素耐藥率,ESBL陽(yáng)性的大腸埃希菌對(duì)常用抗生素耐藥率明顯高于ESBL陰性的大腸埃希菌對(duì)常用抗生素耐藥率。即P均小于0.05都存在顯著性差異,有統(tǒng)計(jì)學(xué)意義。結(jié)論：本地區(qū)超廣譜β-內(nèi)酰胺酶陽(yáng)性的肺炎克雷伯氏菌和超廣譜β-內(nèi)酰胺酶陽(yáng)性的大腸埃希氏菌對(duì)常用抗生素的耐藥率高于超廣譜β-內(nèi)酰胺酶陰性的肺炎克雷伯氏菌和超廣譜β-內(nèi)酰胺酶陰性的大腸埃希氏菌對(duì)常用抗生素的耐藥率,且耐藥率較高,因此對(duì)ESBL陽(yáng)性的菌株臨床應(yīng)當(dāng)參照藥敏試驗(yàn)結(jié)果合理使用抗生素。
[Abstract]:Objective: to detect extended spectrum beta lactamase of extended-spectrum 尾 -lactamases in Zichuan area. Resistance of Klebsiella pneumoniae and ESBL positive Escherichia coli to common antibiotics. To study the application prospect of antibiotics to these two kinds of bacteria in this area. Methods:. To collect 511 strains of Klebsiella pneumoniae and 403 strains of Escherichia coli isolated from August 2013 to October 2014 in Zichuan District Hospital. The ESBL phenotypic confirmatory test method recommended by CLSI was used to detect ESBL. The minimal inhibitory concentration (inhibition concentration) of commonly used antibiotics was determined by broth microdilution method. CLSI(Clinical and Laboratory Standards Institute was used to judge the drug sensitivity. In 2012, M100-S22 standard. Whonet software was used to statistics the data. The results of X2 test were used to detect the antibiotics of Klebsiella pneumoniae, Klebsiella pneumoniae, ESBL negative Klebsiella pneumoniae and ESBL positive Escherichia coli and ESBL negative Escherichia coli. Results:. There were 511 strains of Klebsiella pneumoniae. There were 151 strains of Klebsiella pneumoniae positive for ESBL, and the positive rate was 29.555.The drug resistance rate to commonly used antibiotics was ceftriaxone 96.699.69 and amoxicillin / clavulanic acid 32.45%. Cefoxitin 17.88, ciprofloxacin 31.79, cefepime 17.22, cefazolin 100.00000, gentamicin 64.24, imipenem 0%. There were 360 strains of Klebsiella pneumoniae negative for ESBL. The drug resistance rate to common antibiotics was ceftriaxone 7.78, amoxicillin / clavulanic acid 9.44 and cefoxitin 10.00%. Ciprofloxacin 8.61, cefepime 3.33, cefazolin 13.61, gentamicin 6.39, imipenem 0. Escherichia coli 403. There were 262 strains of Escherichia coli positive for ESBL, the positive rate was 65.01. The drug resistance rate to common antibiotics was ceftriaxone 99.2424, ciprofloxacin 87.79%. Cefepime 50.76, cefoxitin 38.55, amoxicillin / clavulanic acid 27.48, cefazolin 100.00m, gentamicin 56.49 and imipenem 0%. There were 141 strains of Escherichia coli negative for ESBL. The resistance rates to common antibiotics were ceftriaxone 12.06, ciprofloxacin 45.39and cefepime 2.13%. Cefxitin 15.60, amoxicillin / clavulanic acid 18.44, cefazolin 21.99, gentamicin 39.01, imipenem 0. Except imipenem. The results of X2 analysis showed that the resistance rate of Klebsiella pneumoniae positive to common antibiotics was significantly higher than that of ESBL negative Klebsiella pneumoniae. The resistance rate of ESBL positive Escherichia coli to common antibiotics was significantly higher than that of ESBL negative Escherichia coli to common antibiotics (P < 0. 05). Statistically significant. Conclusion:. Extended-spectrum 尾 -lactamase positive Klebsiella pneumoniae and extended-spectrum 尾 -lactamase positive Escherichia coli were more resistant to common antibiotics than extended-spectrum 尾 -lactamase negative pneumonia Klebsiella pneumoniae. Resistance rate of Escherichia coli and extended-spectrum 尾 -lactamase negative Escherichia coli to common antibiotics. The rate of drug resistance was high, so antibiotics should be used reasonably according to the results of drug sensitivity test for ESBL positive strains.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R446.5

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