發(fā)布時間：2018-01-12 21:20

  本文關(guān)鍵詞：ICU中耐碳青霉烯類肺炎克雷伯桿菌感染患者耐藥及預(yù)后的相關(guān)因素分析　出處：《浙江大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 肺炎克雷伯桿菌 耐藥 碳青霉烯 病死率

【摘要】：目的分析ICU中導(dǎo)致耐碳青霉烯類肺炎克雷伯桿菌感染患者耐藥及影響預(yù)后的相關(guān)因素,為細菌耐藥的防治提供臨床參考。方法收集ICU經(jīng)細菌培養(yǎng)鑒定為肺炎克雷伯桿菌的菌株230株,分析培養(yǎng)標(biāo)本來源分布。將190例ICU肺炎克雷伯桿菌感染患者按藥敏試驗結(jié)果分為耐碳青霉烯類組和非耐碳青霉烯類組,收集每例患者臨床情況、抗菌素使用情況及預(yù)后等因素,分析其與耐碳青霉烯類肺炎克雷伯桿菌產(chǎn)生的相關(guān)性,并對2組患者的病死率及影響病死率的相關(guān)因素進行分析。結(jié)果本研究從190例患者中共分離到230個肺炎克雷伯桿菌菌株,從痰中分離的菌株占首位(60%)。2009-2011年三年間耐藥率呈逐年升高的趨勢。肺炎克雷伯桿菌耐藥的產(chǎn)生與感染部位的個數(shù)、碳青霉烯類抗菌素的使用罾切相關(guān)。耐碳青霉烯類組病死率46.90%,非耐碳青霉烯類組病死率33.77%,2組患者病死率在統(tǒng)計學(xué)上無顯著差別。在本研究中,患者患有多臟器功能障礙綜合癥(MODS)、惡性腫瘤及急性生理與慢性健康狀況評估系統(tǒng)(APACHE)II評分、喹諾酮類抗菌素的使用與病死率密切相關(guān)。結(jié)論目前耐碳青霉烯類肺炎克雷伯桿菌感染的比例有逐年升高的趨勢,細菌耐藥的產(chǎn)生是多方面的因素,既與機體感染部位數(shù)量有關(guān),更與抗菌素的暴露相關(guān)。影響感染患者最終轉(zhuǎn)歸的因素也是多方面的,本研究中雖然無法證明耐藥與病死率的直接關(guān)系,但可以證實患者的基礎(chǔ)疾病情況與APACHE Ⅱ評分與患者的轉(zhuǎn)歸有直接關(guān)系,同時本研究發(fā)現(xiàn)喹諾酮類抗菌素的暴露與感染患者的轉(zhuǎn)歸相關(guān)。
[Abstract]:Objective to analyze the ICU cause of carbapenem resistant Klebsiella pneumoniae resistance and influence factors related to prognosis of infection with Klebsiella pneumoniae, and provide clinical reference for the prevention and control of bacterial resistance. Methods ICU the bacterial culture was identified as Klebsiella pneumoniae 230 strains, analysis of the training samples. The distribution of 190 cases of Klebsiella pneumoniae ICU Klebsiella pneumoniae infection patients according to the results of drug sensitive test for carbapenem resistant group and non carbapenem resistant group were collected from every patients, factors of antibiotic use and the prognosis, and the correlation analysis of carbapenem resistant Klebsiella pneumoniae Klebsiella bacillus, and related factors for mortality and the influence of the 2 groups of patients with the mortality rate were analyzed. The results from 190 patients with isolated 230 strains of Klebsiella pneumoniae strains, isolated from sputum accounted for the first (60%) in the three years.2009-2011 resistance rate was Increased year by year. The number and site of infection, Klebsiella pneumoniae resistant to the carbapenem antibiotic use. Zeng is closely related to the carbapenem resistant group the mortality rate was 46.90%, non carbapenem resistant group, the mortality rate was 33.77%, the mortality rate of 2 groups of patients had no significant difference in statistics. In this study, patients with multiple organ dysfunction syndrome (MODS), the evaluation system of malignant tumor and acute physiology and chronic health evaluation (APACHE) II, the use of quinolones and mortality rate are closely related. Conclusion the carbapenem resistant Klebsiella pneumoniae infection ratio increased year by year, bacteria the resistance factors in many aspects, not only related to the number and the site of infection, more related to antibiotic exposure. Factors affecting the final outcome of the patients with infection is also in many aspects, in this study, although no proof of resistance It is directly related to the fatality rate, but it can be confirmed that the basic disease of patients is directly related to the APACHE II score and the outcome of patients. Meanwhile, it is found that the exposure of quinolone antibiotics is related to the outcome of infected patients.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R446.5

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本文編號：1416051