本文關(guān)鍵詞：430株急診ICU病原菌分布及耐藥性回顧性調(diào)查　出處：《南昌大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 急診ICU 細(xì)菌分布 耐藥性 病原菌

【摘要】：目的:調(diào)查南昌大學(xué)第一附屬醫(yī)院急診ICU病房病原菌群分布及其耐藥現(xiàn)狀,調(diào)查急診ICU病人社區(qū)獲得性和院內(nèi)獲得性多重耐藥菌定植或感染率,為指導(dǎo)臨床合理用藥和醫(yī)院內(nèi)感染控制提供細(xì)菌學(xué)依據(jù)。方法:1、通過(guò)回顧性調(diào)查方法搜集2013年11月至2015年3月南昌大學(xué)第一附屬醫(yī)院急診ICU住院病人送檢標(biāo)本培養(yǎng)、分離、鑒定和藥敏試驗(yàn)結(jié)果,分析臨床常見(jiàn)病原菌的菌群分布和耐藥性,使用Excell和SPSS13.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。2、采用前瞻性設(shè)計(jì),收集2014年10月至2015年2月我南昌大學(xué)第一附屬醫(yī)院急診ICU新入院入科時(shí)、入科后48小時(shí)、7日及出科前的鼻前庭分泌物,做細(xì)菌分離鑒定和藥敏實(shí)驗(yàn),使用Excell表進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1、2013年11月至2015年3月南昌大學(xué)第一附屬醫(yī)院急診ICU共收治病人690例,采集1052例臨床送檢標(biāo)本。2、病原菌主要來(lái)源于呼吸道最高,321株(4.66%),其次為血液36株(8.37%)和尿液28株(6.5%),創(chuàng)面分泌物24株(5.58%),其他腹水、胸水、糞便、腦脊液、導(dǎo)管尖端等共占4.88%。3、16個(gè)月從臨床送檢標(biāo)本中共分離獲得430株病原菌,其中355株細(xì)菌,75株真菌,分離病原菌陽(yáng)性率為40.87%。革蘭氏陰性桿菌(G-)306株,占總細(xì)菌數(shù)的86.2%,革蘭氏陽(yáng)性球菌(G+)49株,占總細(xì)菌數(shù)的13.8%。急診ICU前六位細(xì)菌分別為:鮑曼不動(dòng)桿菌(29.01%),銅綠假單胞菌(9.58%),大腸埃希氏菌(9.01%),肺炎克雷伯氏菌(8.17%),嗜麥芽黃單胞菌(6.76%),金黃色葡萄球菌(5.63%)。革蘭氏陽(yáng)性菌49株,包括:金黃色葡萄球菌最多(40.8%),其次是屎腸球菌、人葡萄球菌亞種、表皮葡萄球菌、溶血性葡萄球菌、草綠色鏈球菌。屎腸球菌株明顯較糞腸球菌多。真菌共計(jì)75株,以白色念珠菌最多。4、耐藥性分析:革蘭氏陰性菌耐藥情況嚴(yán)重,其中鮑曼不動(dòng)桿菌耐藥情況十分嚴(yán)重,大多呈現(xiàn)多重耐藥和泛耐藥,多耐和泛耐的檢出率為61.1%。耐甲氧西林金黃色葡萄球菌的檢出率高(60%),替考拉寧藥敏未做,利奈唑胺的耐藥率為10%,未發(fā)現(xiàn)耐萬(wàn)古霉素的金黃色葡萄球菌;未發(fā)現(xiàn)對(duì)萬(wàn)古霉素、替考拉寧、利奈唑胺耐藥的糞腸球菌和屎腸球菌。白色念珠菌對(duì)各種抗真菌藥物均有較高的敏感性,對(duì)氟康唑、伏立康唑、5-氟胞嘧啶、兩性霉素-B 90%敏感。5鼻前庭咽拭子培養(yǎng)的結(jié)果:入科的120例病人中有59例入科時(shí)鼻前庭咽拭子標(biāo)本中分離出常見(jiàn)的細(xì)菌,占病人數(shù)的49.2%,其中多重耐藥菌占多數(shù)。入科48小時(shí)后咽拭子標(biāo)本培養(yǎng)出ICU新的病原菌58株,72小時(shí)后培養(yǎng)成70株病原菌,出院前培養(yǎng)出22株病原菌。檢出率高的病原菌為金黃色葡萄球菌、大腸埃希氏菌、鮑曼不動(dòng)桿菌、銅綠假單胞菌、副流感嗜血桿菌、嗜麥芽黃單胞菌等,未見(jiàn)明顯定植率特別高的致病菌。結(jié)論:1、南昌大學(xué)第一附屬醫(yī)院急診ICU分離的病原菌標(biāo)本的來(lái)源主要以呼吸道和血液、泌尿生殖道為主。病原菌種類多,以革蘭氏陰性桿菌為主要病原菌,其中以鮑曼不動(dòng)桿菌、銅綠假單胞菌、大腸埃希氏菌、肺炎克雷伯氏菌為主,大部分對(duì)常用抗菌藥物高度耐藥和多重耐藥性。耐甲氧西林金黃色葡萄球菌檢出率高,呈多重耐藥。真菌檢出率高,以白色念珠菌為主。臨床抗感染治療形勢(shì)嚴(yán)峻,故臨床醫(yī)師應(yīng)加強(qiáng)病原學(xué)和耐藥性監(jiān)測(cè),根據(jù)藥敏監(jiān)測(cè)結(jié)果合理選用抗菌藥物,以提高治愈率。2、南昌大學(xué)第一附屬醫(yī)院急診ICU病人社區(qū)獲得性MRS菌株比例較高,提示社區(qū)獲得性-MRS感染者也會(huì)逐步增多。我科入院后多重耐藥菌定植或感染率高,應(yīng)當(dāng)宜加強(qiáng)院感控制和病原學(xué)和耐藥性監(jiān)測(cè),減少院內(nèi)交叉感染。
[Abstract]:Objective: To investigate the First Affiliated Hospital of Nanchang University ICU ward pathogenic bacteria distribution and drug resistance status, investigation of emergency ICU patients with community-acquired and nosocomial multi drug resistant bacteria colonization or infection, provide the bacteriological basis for infection control and guide the clinical rational use of drugs in hospital. Methods: 1, separated by a retrospective survey method to collect the first the Affiliated Hospital of Nanchang University from November 2013 to March 2015 of emergency ICU patients were collected, the culture, identification and drug sensitivity test, analysis of flora distribution and drug resistance of common clinical pathogenic bacteria, were analyzed using.2 Excell and SPSS13.0 software, using a prospective design, collected from October 2014 to February 2015 in the First Affiliated Hospital of Nanchang University, I ICU newly admitted into the hospital emergency department at 48 hours after into the hospital, and 7 days after nasal secretions before, bacterial isolation and drug sensitive test, the Statistical analysis was performed using Excell. Results: 690 cases of emergency ICU were admitted to the First Affiliated Hospital of Nanchang University from November 12013 to March 2015, were collected from 1052 clinical specimens of.2, the main pathogens from respiratory tract, 321 strains (4.66%), followed by blood and urine of 36 strains (8.37%) and 28 strains (6.5%), wound secretion the other 24 strains (5.58%), ascites, pleural effusion, cerebrospinal fluid, feces, catheter tip accounted for 4.88%.3,16 months were isolated 430 strains of pathogenic bacteria from the clinical specimens, including 355 strains of bacteria, 75 strains of fungi, isolation rate of pathogens were gram negative bacillus 40.87%. (G-) 306 strains, total bacteria the number of 86.2%, gram positive cocci and 49 strains (G+), the total number of bacteria 13.8%. emergency ICU top six bacteria were: Bauman Acinetobacter (29.01%), Pseudomonas aeruginosa (9.58%), Escherichia coli (9.01%), Klebsiella pneumoniae (8.17%), from wheat Bud Xanthomonas (6.76%), Staphylococcus aureus (5.63%). 49 strains of gram positive bacteria, including Staphylococcus aureus, most (40.8%) followed by Enterococcus faecium, Staphylococcus species, Staphylococcus epidermidis, Staphylococcus haemolyticus, Streptococcus viridans. Enterococcus strains than Enterococcus faecalis a total of 75 strains of fungi. Candida albicans, most.4, drug resistance analysis of gram negative bacteria resistant in serious condition, in which Bauman Acinetobacter resistance is very serious, mostly showed multiple drug resistance and multidrug resistance and Pan Pan resistant, the detected rate of 61.1%. detection rate of methicillin resistant Staphylococcus aureus (high 60%), teicoplanin susceptibility without resistance to linezolid, the rate was 10%, no vancomycin resistant Staphylococcus aureus to vancomycin, teicoplanin; found that linezolid resistant Enterococcus faecalis and Enterococcus faecium on Candida albicans. The sensitivity of various antifungal drugs had higher to fluconazole, voriconazole, amphotericin 5- and flucytosine, -B 90%.5 sensitive nasal vestibular swab culture results: 120 patients in department in 59 cases of nasal vestibule into the throat swab specimens of isolated bacteria, accounting for 49.2% of the number of patients. The multi drug resistant bacteria accounted for the majority. Cultivate new strains of pathogenic bacteria in the ICU 58 pharyngeal swab specimens into the hospital after 48 hours, 72 hours after cultured 70 strains of pathogenic bacteria, before discharge produced 22 strains of pathogenic bacteria. The detection rate of pathogenic bacteria is high as Staphylococcus aureus, Escherichia coli, Acinetobacter Bauman coli, Pseudomonas aeruginosa, Haemophilus parainfluenzae, Xanthomonas maltophilia, no obvious pathogenic bacteria colonization rate is particularly high. Conclusion: 1, from the First Affiliated Hospital of Nanchang University were isolated pathogens of emergency ICU mainly in the respiratory tract and blood, urinary and reproductive tract for The main pathogenic bacteria species, gram negative bacteria were the main pathogens, which Bauman Acinetobacter, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, most highly resistant to commonly used antibiotics and multi drug resistance. Methicillin resistant Staphylococcus aureus detection rate is high, the multi drug resistance. The high detection rate of fungi, Candida albicans. The clinical anti infection treatment situation is grim, so clinicians should strengthen the monitoring of pathogenic and drug resistance, reasonable use of antibiotics based on the drug susceptibility results, in order to improve the cure rate of.2, the First Affiliated Hospital of Nanchang University of emergency ICU in patients with community-acquired MRS strains will prompt higher proportion gradual increase in community-acquired -MRS infections in our department. After admission of multi drug resistant bacteria colonization or infection rate is high, should strengthen hospital infection control and appropriate pathogen and drug resistance monitoring, reduce hospital cross Infected.

【學(xué)位授予單位】：南昌大學(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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