本文選題：腸桿菌科　切入點：碳青霉烯酶　出處：《華北理工大學(xué)》2015年碩士論文

【摘要】：目的了解我院臨床分離的對碳青霉烯類抗生素不敏感的腸桿菌科細(xì)菌感染患者的臨床特征,對常用抗菌藥物的耐藥性,明確產(chǎn)碳青霉烯酶表型和NDM-1基因型檢出情況。方法收集我院2013年4月到2014年3月臨床分離的對碳青霉烯類抗生素不敏感的腸桿菌科細(xì)菌作為研究對象。采用改良Hodge試驗檢測細(xì)菌是否產(chǎn)碳青霉烯酶,雙紙片協(xié)同試驗篩查金屬β-內(nèi)酰胺酶。對高度耐藥的腸桿菌科細(xì)菌利用特異性引物進(jìn)行NDM-1基因PCR擴(kuò)增,采用雙脫氧末端終止法進(jìn)行DNA測序,所測序列與Gen Bank基因庫中的已知序列進(jìn)行BLAST比對,以明確所測細(xì)菌的基因型。結(jié)果1菌株分布情況:我院2013年4月到2014年3月臨床標(biāo)本中分離出30株對碳青霉烯類抗生素不敏感的腸桿菌科細(xì)菌,其中肺炎克雷伯菌16株,占53.3%;陰溝腸桿菌12株,占40.0%;弗勞地枸櫞酸桿菌和布氏枸櫞酸桿菌各1株。這些細(xì)菌來自不同的科室,但主要分布在重癥醫(yī)學(xué)科15株(50.0%),神經(jīng)內(nèi)科重癥病房8株(26.7%),其次為普通外科4株(13.3%),神經(jīng)內(nèi)科、呼吸內(nèi)科和康復(fù)科各1株。標(biāo)本主要來源于痰20株,占66.7%,其次為尿液5株(16.7%),血液4株(13.3%),引流液1株(3.3%)。2藥物敏感性試驗結(jié)果:30株細(xì)菌對氨芐西林、頭孢菌素類、含β-內(nèi)酰胺酶抑制劑的復(fù)合制劑和單環(huán)β-內(nèi)酰胺類抗生素的耐藥率最高,均為100%;對碳青霉烯類抗生素亞胺培南和美洛培南的耐藥率分別為100%和86.7%;對四環(huán)素、氯霉素、慶大霉素、左氧氟沙星、環(huán)丙沙星的耐藥率在66.7%~93.3%之間;對多粘菌素最敏感,敏感率高達(dá)100%,其次為復(fù)方新諾明和阿米卡星,敏感率分別為66.7%和46.7%。3表型確認(rèn)結(jié)果:30株細(xì)菌中,26株改良Hodge試驗陽性,即檢出產(chǎn)碳青霉烯酶細(xì)菌26株,陽性率為86.7%(26/30);18株雙紙片協(xié)同試驗陽性,即檢出產(chǎn)金屬β-內(nèi)酰胺酶細(xì)菌18株,陽性率為60.0%(18/30)。4 NDM-1基因確證結(jié)果:對高度耐藥的腸桿菌科細(xì)菌進(jìn)行NDM-1基因確證,共有5株為產(chǎn)NDM-1菌株。5株菌包括肺炎克雷伯菌2株,陰溝腸桿菌2株,布氏枸櫞酸桿菌1株;其中分布在重癥醫(yī)學(xué)科3株,神經(jīng)內(nèi)科重癥病房2株;3株分離自患者尿液,2株分離自患者痰。5株細(xì)菌對多粘菌素均敏感,3株對復(fù)方新諾明敏感,2株對阿米卡星敏感;而對常見的β-內(nèi)酰胺類抗生素以及喹諾酮類、四環(huán)素類、氯霉素類等非β-內(nèi)酰胺類抗生素均耐藥。5株產(chǎn)NDM-1菌株改良Hodge試驗以及雙紙片協(xié)同試驗結(jié)果均為陽性。5感染患者臨床特征:30株腸桿菌科細(xì)菌分離自28例患者。28例細(xì)菌感染患者平均年齡約為74歲,多有較嚴(yán)重的呼吸道疾病,心腦血管疾病,嚴(yán)重外傷,重癥感染等基礎(chǔ)疾病,平均住院時間8個月。其中5株產(chǎn)NDM-1菌株分離自4例患者,感染患者平均年齡為73歲,2例腦梗死,1例腎功能不全,1例感染性休克,平均住院時間10個月。4例細(xì)菌感染患者最終2例存活,2例死亡。結(jié)論1我院臨床分離的對碳青霉烯類抗生素不敏感的腸桿菌科細(xì)菌主要以肺炎克雷伯菌和陰溝腸桿菌為主,在臨床主要引起病人下呼吸道感染,對臨床常用抗菌藥物表現(xiàn)為多重耐藥。2我院腸桿菌科細(xì)菌已出現(xiàn)產(chǎn)NDM-1菌株,其主要引起病人泌尿系統(tǒng)感染和下呼吸道感染。年老體弱,嚴(yán)重的基礎(chǔ)疾病,長期住院,侵入性治療,這些都是產(chǎn)NDM-1菌株產(chǎn)生的誘發(fā)因素。感染產(chǎn)NDM-1菌株患者的死亡是由嚴(yán)重的基礎(chǔ)疾病引起的,而與感染產(chǎn)NDM-1細(xì)菌并無直接的關(guān)系。3產(chǎn)NDM-1菌株除了對多粘菌素全部敏感,對復(fù)方新諾明和阿米卡星部分敏感外,對其他類抗生素全部耐藥,臨床在治療此類細(xì)菌引起的感染時可進(jìn)行參考。
[Abstract]:Objective to investigate the clinical isolates in our hospital of carbapenem sensitive of bacteria of Enterobacteriaceae infections in patients with clinical features, of antibiotic resistance, clear carbapenemase producing phenotype and NDM-1 genotype detection. Methods collected in our hospital from April 2013 to March 2014 the clinical separation is not sensitive to carbapenems antibiotics of the Enterobacteriaceae bacteria as the research object. By detecting the modified Hodge test whether carbapenemases, double disk synergy test screening of metallo beta lactamase. Specific primers of Enterobacteriaceae based on highly drug-resistant NDM-1 gene was amplified by PCR, using the dideoxy method for DNA sequencing, the measuring the known sequence Gen sequence and Bank gene library of BLAST in comparison, clear genotype measured by bacteria. Results 1 strains distribution: in our hospital from April 2013 to March 2014 Pro Isolation of 30 strains is not sensitive to carbapenems in Enterobacteriaceae clinical specimens, including 16 strains of Klebsiella pneumoniae, accounting for 53.3%; 12 strains of Enterobacter cloacae, accounted for 40%; Citrobacter freundii and Citrobacter freundii 1 strains. These bacteria from different departments, but mainly in the ICU of 15 strains (50%), Department of Neurology ICU 8 strains (26.7%), followed by general surgery, 4 strains (13.3%), Department of Neurology, Department of respiratory medicine and Rehabilitation Department of the 1 strains. 20 strains from sputum specimens, accounting for 66.7%, followed by the urine of 5 strains (16.7%). The blood of 4 strains (13.3%), 1 strains (3.3%) drainage.2 drug sensitivity test results: 30 strains of bacteria to ampicillin, cephalosporins, drug containing beta lactamase inhibitor compound and monobactam antibiotic. The highest rate was 100%; resistant to carbapenems imipenem and meropenem Rates were 100% and 86.7%; tetracycline, chloramphenicol, gentamicin, levofloxacin, ciprofloxacin resistance rate was 66.7%~93.3%; the most sensitive to polymyxin, sensitive rate as high as 100%, followed by cotrimoxazole and Amikacin, the sensitive rates were 66.7% and 46.7%.3 confirmed phenotypic results: 30 strains of bacteria. 26 strains of modified Hodge test positive detection of carbapenemase produced 26 bacterial strains, the positive rate was 86.7% (26/30); 18 strains of double disk synergy test is positive, i.e. producers of metallo beta lactamase 18 bacterial strains, the positive rate was 60% (18/30).4 NDM-1 gene confirmed: NDM-1 gene was confirmed Enterobacteriaceae of highly resistant, a total of 5 strains of NDM-1 producing strains.5 strains including 2 strains of Klebsiella pneumoniae, 2 strains of Enterobacter cloacae, Citrobacter freundii 1 strains; the distribution in ICU of 3 strains, 2 strains of the ICU Department of Neurology; 3 strains isolated from patients Urine, 2 strains isolated from sputum bacterial strains in.5 were sensitive to polymyxin, 3 strains of cotrimoxazol-sensitive, 2 strains were sensitive to Amikacin; and tetracycline on common beta lactam antibiotics such as chloramphenicol, quinolones, and non beta lactam antibiotic resistant.5 strains strain NDM-1 modified Hodge test and double disc synergy test results for clinical characteristics of patients with positive.5 infection: 30 strains of Enterobacteriaceae isolated from 28 patients with.28 cases of bacterial infection in patients with an average age of about 74 years, there are more severe respiratory disease, cardiovascular disease, severe trauma, severe infection and other diseases and the average hospitalization time was 8 months. Among the 5 strains of NDM-1 producing strains were isolated from 4 patients, infection in patients with an average age of 73 years, 2 cases of cerebral infarction, 1 cases of renal insufficiency, 1 cases of septic shock, the average hospitalization time was 10 months.4 cases of bacterial infection in patients with the final 2 The patients survived, 2 cases died. Conclusion: 1 our hospital clinical isolates of carbapenem sensitive Enterobacteriaceae in Klebsiella pneumoniae and Enterobacter cloacae, in clinical patients mainly caused lower respiratory tract infections, to antibiotics showed multiple drug resistant Escherichia coli.2 in our hospital there has been NDM-1 producing strains of bacteria, the main cause of patients with urinary system infection and lower respiratory tract infection. The frail elderly, basic diseases, serious long-term hospitalization, invasive treatment, these are the inducing factors of NDM-1 producing strains. NDM-1 producing strains infection is caused by the death of patients with severe underlying diseases, and with the infection of NDM-1 producing bacteria have no direct relationship between.3 in addition to NDM-1 producing strains were completely sensitive to polymyxin, to cotrimoxazole and Amikacin some sensitive to other antibiotics, all clinical in the treatment of such resistance. A bacterial infection can be used for reference.

【學(xué)位授予單位】：華北理工大學(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：1679261