本文關(guān)鍵詞： 細(xì)菌耐藥性 監(jiān)測 超廣譜 β-內(nèi)酰胺酶 TEM SHV CTX-M 大腸埃希菌 肺炎克雷伯菌　出處：《寧夏醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:研究2013年蘭州地區(qū)某三甲醫(yī)院臨床分離菌的分布和耐藥特征,并對分離率較高的大腸埃希菌以及肺炎克雷伯菌中產(chǎn)超廣譜β-內(nèi)酰胺酶基因進(jìn)行分型研究,了解蘭州地區(qū)某三甲醫(yī)院ESBLs的基因型,為臨床合理選擇抗菌藥物提供依據(jù)。方法:以蘭州地區(qū)某三甲醫(yī)院2013年1月至2013年12月從臨床分離的所有菌株為研究對象,采用紙片擴(kuò)散法(K-B法)對分離菌株進(jìn)行藥敏試驗(yàn)根據(jù)CLSI 2013年標(biāo)準(zhǔn)判定藥敏結(jié)果,用WHONET5.6軟件對耐藥性結(jié)果進(jìn)行分析;用雙紙片協(xié)同法對大腸埃希菌產(chǎn)超廣譜β-內(nèi)酰胺酶菌株進(jìn)行表型確證;隨機(jī)選取40株大腸埃希菌、20株肺炎克雷伯菌,應(yīng)用PCR、瓊脂糖膠凝膠電泳技術(shù)檢測SHV、TEM以及CTX-M基因的攜帶情況。結(jié)果:2013年蘭州地區(qū)某三甲醫(yī)院共分離出細(xì)菌3160株(非重復(fù)株),其中革蘭陰性桿菌占74.4%。大腸埃希菌、肺炎克雷伯菌中產(chǎn)ESBLs株的檢出率分別為59.9%(292/870),26.4%(111/536)。碳青霉烯類藥物仍然是腸桿菌科等革蘭陰性桿菌最敏感的藥物。產(chǎn)ESBLs大腸埃希菌中TEM的檢出率為5.0%(2/40),SHV的檢出率為42.5%(17/40),CTX-M基因檢出率為85.0%(34/40);產(chǎn)ESBLs肺炎克雷伯菌中TEM的檢出率為20.0%(4/20),SHV的檢出率為75.0%(15/20),CTX-M基因檢出率為75.0%(15/20)。結(jié)論:腸桿菌科細(xì)菌是主要的臨床分離病原菌,大腸埃希菌和肺炎克雷伯菌是最常見的腸桿菌科病原菌。產(chǎn)ESBLs是大腸埃希菌和肺炎克雷伯菌最主要的耐藥機(jī)制。產(chǎn)ESBLs是大腸埃希菌和肺炎克雷伯菌對常用的β-內(nèi)酰胺類、氨基糖苷類、喹諾酮類抗菌藥物的耐藥率比非產(chǎn)ESBLs菌株的耐藥率普遍偏高;大腸埃希菌和肺炎克雷伯菌產(chǎn)ESBLs的基因型主要為CTX-M型,其次為SHV型,TEM型的檢出率最低。大腸埃希菌和肺炎克雷伯菌產(chǎn)ESBLs的基因型CTX-M型、SHV型和TEM型單獨(dú)檢出率較低,大部分菌株都含有2種或2種以上的,多種基因型共存于同一株菌中,介導(dǎo)細(xì)菌產(chǎn)生復(fù)雜的耐藥表型。CTX-M型單獨(dú)或合并有SHV、TEM型ESBLs對頭孢噻肟的耐藥率比頭孢他啶和氨曲南的耐藥率高。產(chǎn)ESBLs菌株的廣泛傳播,應(yīng)引起廣泛的關(guān)注只有加強(qiáng)細(xì)菌耐藥監(jiān)測并從分子水平對其耐藥機(jī)制進(jìn)行研究,才能合理規(guī)范使用抗菌藥物,預(yù)防醫(yī)院感染流行的發(fā)生。
[Abstract]:Objective: to study the distribution and drug resistance of clinical isolated bacteria in a third Class A Hospital in Lanzhou area in 2013. The genotypes of extended-spectrum 尾 -lactamases in Escherichia coli and Klebsiella pneumoniae with high isolation rate were studied to understand the genotype of ESBLs in a third class hospital in Lanzhou. Methods: all strains isolated from clinic from January 2013 to December 2013 in a third class hospital in Lanzhou area were studied. The drug sensitivity test of isolated strains was carried out by using disk diffusion method (K-B method) according to the CLSI 2013 standard, and the results of drug resistance were analyzed by WHONET5.6 software. The phenotype of extended-spectrum 尾 -lactamase producing strains of Escherichia coli was confirmed by double disk synergy method. Forty strains of Escherichia coli and 20 strains of Klebsiella pneumoniae were randomly selected to detect SHV by agarose gel electrophoresis. Results: in 2013, a total of 3160 strains (non-repeats) of bacteria were isolated from a third Class A Hospital in Lanzhou area. The positive rate of ESBLs in Escherichia coli and Klebsiella pneumoniae was 59.9% and 29.2% respectively. 26.4The carbapenem is still the most sensitive drug in Gram-negative bacilli such as Enterobacteriaceae. The detection rate of TEM in ESBLs producing Escherichia coli is 5.0% (. 2 / 40). The detection rate of CTX-M gene in SHV was 42.5% and the detection rate of CTX-M gene was 85.0%. The detection rate of TEM in Klebsiella pneumoniae was 20.0% and 75.0% (15 / 20). The detection rate of CTX-M gene was 75.0 / 20. Conclusion: Enterobacteriaceae is the main clinical isolated pathogen. Escherichia coli and Klebsiella pneumoniae are the most common pathogens of Enterobacteriaceae. ESBLs production is the main drug resistance mechanism of Escherichia coli and Klebsiella pneumoniae. ESBLs production is Escherichia coli and Klebsiella pneumoniae. Primary bacteria against 尾-lactams in common use. The resistance rate of aminoglycosides and quinolones was higher than that of non-producing ESBLs strains. The genotype of Escherichia coli and Klebsiella pneumoniae producing ESBLs was mainly CTX-M type, followed by SHV type. The detection rate of TEM type was the lowest, and that of Escherichia coli and Klebsiella pneumoniae genotype CTX-M and TEM was lower. Most of the strains contain two or more than two genotypes coexisting in the same strain which mediates the production of complex drug-resistant phenotype. CTX-M alone or combined with SHV. The resistance rate of TEM type ESBLs to cefotaxime was higher than that of ceftazidime and aztreonam. ESBLs producing strains were widely spread. Only by strengthening the monitoring of bacterial drug resistance and studying the mechanism of drug resistance at molecular level can the use of antimicrobial agents be reasonably standardized and the prevalence of nosocomial infection be prevented.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R446.5

【共引文獻(xiàn)】

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