本文關(guān)鍵詞：某三級甲等醫(yī)院多重耐藥菌感染現(xiàn)狀研究　出處：《山東大學》2015年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 多重耐藥菌 科室分布 易感因素預測 耐藥趨勢

【摘要】：研究背景中國MRSA(耐甲氧西林金黃色葡萄球菌)監(jiān)測率達50%,在國際上排名居前；ESBL(產(chǎn)超廣譜β內(nèi)酰胺酶桿菌)、CRE(耐碳青酶烯類腸桿科細菌)、MDRAB (多重耐藥鮑曼不動桿菌)等在綜合性醫(yī)院檢出比例均較高。MRSA感染幾乎遍及全球,成為臨床上最常見的病原菌之一,與艾滋病、乙型肝炎一起被稱為當今世界三大感染頑疾。各類抗菌藥物,尤其是廣譜抗菌藥物的廣泛使用,臨床細菌耐藥形式嚴峻,已成為國內(nèi)外醫(yī)藥界備受關(guān)注的問題。為保障醫(yī)療安全,同時使醫(yī)務人員更好的了解多重耐藥菌的易感因素和耐藥趨勢,及早采取合理治療及防控措施,提高醫(yī)療機構(gòu)診治水平和防控醫(yī)院感染,特作以下研究。研究目的1、探討多重耐藥菌易感因素與耐藥菌趨勢變化情況；2、根據(jù)易感因素及多重耐藥菌特點,作出多重耐藥菌感染的預測；3、分析各種類型多重耐藥菌的耐藥率,可為臨床醫(yī)生的經(jīng)驗性治療提供依據(jù)；4、根據(jù)多重耐藥菌檢出來源,可采取相關(guān)控制措施予以阻斷,防止患者的交叉感染；5、通過對多重耐藥菌醫(yī)院感染病例分析,指導臨床醫(yī)務人員開展治療、護理與防控工作。研究方法回顧性調(diào)查2013年-2014年蚌埠市第三人民醫(yī)院檢出的各種多重耐藥菌,并對患者的基礎(chǔ)資料、標本來源、細菌藥敏試驗結(jié)果等進行統(tǒng)計分析。根據(jù)監(jiān)測結(jié)果,作出多重耐藥菌的科室分布與耐藥趨勢變化。通過對患者的基本情況進行卡方檢驗,評價相關(guān)多重耐藥菌與年齡、性別、標本來源的關(guān)系。分析多重耐藥菌的醫(yī)院感染病例可對醫(yī)院感染病例進行有針對性的防控。根據(jù)相關(guān)文獻查閱、細菌學特點、科室分布以及相關(guān)檢驗做多重耐藥菌的易感因素預測,從而能使臨床醫(yī)生在初診病人時,可及時考慮多重耐藥菌感染的可能性,及早合理選擇針對性的抗菌藥物治療。主要結(jié)果制定出多重耐藥菌科室分布圖及耐藥趨勢變化圖。可明顯得出多重耐藥菌分布以ICU、骨科、普通外科等科室為主,易感因素主要有年齡、侵襲性操作等。MRSA耐藥率在40%以上的有紅霉素、克林霉素、左氧氟沙星、四環(huán)素、利福平、慶大霉素；耐藥率在40%以下的有萬古霉素、替考拉寧、復方新諾明。在臨床治療懷疑金黃色葡萄球菌感染時應予以參考。ESBL大腸埃希菌耐藥率在40%以上的有慶大霉素、復方新諾明、環(huán)丙沙星：耐藥率在40%以下的有頭孢西丁、哌拉西林/他唑巴坦、美羅培南、亞胺培南、阿米卡星；其中,頭孢西丁耐藥率在30%至40%之間。ESBL大腸埃希菌檢出率較高的普通外科等科室,應在使用抗菌藥物預防與治療時予以參考。ESBL肺炎克雷伯菌耐藥率與產(chǎn)ESBL大腸埃希菌相比較,對各種抗生素的耐藥率略低。產(chǎn)CRE肺炎克雷伯菌臨床檢出例數(shù)增長較快,雖占比不高,但由于可能產(chǎn)KPC酶,針對此類細菌應予以密切關(guān)注,防止較多CRE病例出現(xiàn)。MDRAB對臨床多種常見抗菌藥物耐藥率均較高,屬泛耐藥鮑曼不動桿菌,其在多重耐藥菌總量中構(gòu)成比較高,應引起關(guān)注。針對患者入住ICU、年齡、送檢標本以及慢性炎癥、抗菌藥物的選擇等均可作為多重耐藥菌感染的預測因素及標準。根據(jù)不同科室收治患者不同,臨床醫(yī)師可根據(jù)相關(guān)特點,在患者考慮感染時作出相關(guān)預測。作為醫(yī)院感染管理控制部門,應嚴控檢出較多科室,并加強與微生物實驗室聯(lián)系,提高感染暴發(fā)預警意識,同時加強與幾個檢出較多的臨床科室建立重點聯(lián)系,對該類細菌感染建議聯(lián)用抗菌藥物評價臨床效果。結(jié)論與建議多重耐藥菌檢出比例增高明顯,各科室均有分布,臨床醫(yī)師可結(jié)合患者原發(fā)病以及相關(guān)易感因素作出多重耐藥菌感染的預測,從而能及時合理的選擇敏感抗菌藥物。多重耐藥菌的感染病例較多,不僅局限于醫(yī)院內(nèi),較多慢性炎癥患者在長期廣泛使用抗菌藥物治療后極易產(chǎn)生細菌耐藥,導致多重耐藥菌的產(chǎn)生,多重耐藥菌的控制應作為一項公共衛(wèi)生事件來予以干預,納入相關(guān)重點疾病研究,從各個環(huán)節(jié)控制抗菌藥物的濫用,開展醫(yī)院高發(fā)科室的去定植工作,從而有效遏制多重耐藥菌的產(chǎn)生。
[Abstract]:On the background of China MRSA (methicillin-resistant Staphylococcus aureus) monitoring rate of 50% in the international ranking; ESBL (ESBLs strains), CRE (carbapenem resistant Enterobacteriaceae), MDRAB (multi drug resistant Acinetobacter Bauman) in general the detection rate of hospital infection of.MRSA were higher in almost all over the world, become one of the most common pathogens in clinical and AIDS, hepatitis B is called the world's three ills. Infection of various antibacterial drugs, especially the widespread use of broad-spectrum antibiotics, clinical bacteria resistant forms of severe, has been paid much attention at home and abroad the medical profession. To ensure medical safety, and medical personnel to better understand the multiple drug-resistant bacteria susceptible factors and the trend of drug resistance, to take reasonable treatment and prevention and control measures as soon as possible, improve the level of diagnosis and treatment of medical institutions and hospital infection prevention and control, especially for The following research. Objective: 1, to investigate multiple drug-resistant bacteria susceptible to changes in trend factors and drug resistant bacteria; 2, and according to the characteristics of multi drug resistant bacteria susceptible factors, make a prediction of multi drug resistant bacteria infection; 3, analysis of drug resistance of multidrug resistant bacteria of various types, can provide the basis for the empirical treatment of clinicians; 4. According to the multi drug resistant bacteria source, can take control measures to block, to prevent cross infection of patients; 5, through the analysis of the cases of multi drug resistant bacteria infection in hospital, clinical medical personnel to carry out the treatment, nursing and Prevention and control work. All kinds of multi drug resistant bacteria research methods retrospective survey in 2013 in Bengbu Third People's Hospital during -2014 detection, and on the basis of data were collected from drug sensitivity test results were analyzed. According to the monitoring results of multi drug resistant bacteria distribution and drug resistance tendency of Department Change. Chi square test was carried out through the basic situation of patients, evaluation of multidrug-resistant bacteria with age, sex, relationship between the specimen source. Analysis of cases of nosocomial infection cases for targeted prevention and control of multidrug-resistant bacteria in hospital. According to the relevant literature, the characteristics of bacteria, distribution of departments and relevant test for multiple drug resistant bacteria susceptible factors, which can make the clinicians in the newly diagnosed patients, may consider the possibility of multi drug resistant bacteria infection in a timely manner, a reasonable choice for early antibiotic treatment. The main results and formulate of multiple drug resistant bacteria distribution and drug resistance of the department changes. The Department of orthopedics may appear out of multidrug resistant bacteria in ICU, general surgery department, the predisposing factors include age, invasive operation.MRSA resistance rate in more than 40% of the erythromycin, clindamycin, tetracycline and levofloxacin, Li Fuping, gentamicin; drug resistance rate of 40% or less are teicoplanin, vancomycin, cotrimoxazole. In the clinical treatment of suspected Staphylococcus aureus infection should be.ESBL reference Escherichia coli resistance rate in more than 40% of the gentamicin, cotrimoxazole, ciprofloxacin resistance rate below 40% of the cefoxitin, piperacillin / tazobactam, imipenem, meropenem, Amikacin; among them, cefoxitin was between 30% and 40%.ESBL of Escherichia coli was higher rate of general surgery department, drug prevention and treatment should be in use to refer to.ESBL Klebsiella pneumoniae compared with the rate of production the ESBL of Escherichia coli, resistant to various antibiotics was slightly low. CRE producing Klebsiella pneumoniae clinical detection the number of cases increased rapidly, although the proportion is not high, but due to the possibility of producing KPC enzyme, the bacteria should be. Cut to prevent more attention, CRE cases of.MDRAB antibiotics were higher in various clinical common genera of Pan drug resistant Acinetobacter Bauman, the multi drug resistant bacteria is higher in total, should be paid more attention. For patients in the ICU age, and the specimens of chronic inflammation, the choice of antibiotics could be used as prediction the factors of multi drug resistant bacteria infection and standard. According to the different departments from patients, clinicians can according to relevant characteristics, make relevant prediction in patients considered infection. As the management of hospital infection control department, should strictly control the detected more departments, and strengthen ties with the microbiology laboratory, improve the outbreak warning consciousness, and strengthen the establishment of key clinical contact the Department with a few more of this type of detection, bacterial infection suggest antibiotic clinical evaluation. The conclusion and suggestion of multiple drug resistant bacteria than Patients increased significantly, each department has distribution, clinicians can patients with primary disease and related risk factors to predict the multi drug resistant bacteria infection combined to timely and reasonable selection of sensitive antibiotics. Multi drug resistant bacteria infections are not only confined to the hospital, many patients with chronic inflammation prone to bacterial resistance in long term the use of antimicrobial drugs after treatment, resulting in multiple drug-resistant bacteria, control of multidrug-resistant bacteria should be used as a public health emergency to be included in the relevant research focus of disease intervention, from all aspects of control system, abuse of antibiotics, hospital departments to work in planting, in order to effectively curb the multidrug-resistant bacteria.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R446.5

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