發(fā)布時(shí)間：2018-05-02 14:52

  本文選題：鮑曼不動(dòng)桿菌 + 抗菌藥物��； 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：目的 了解吉林大學(xué)中日聯(lián)誼醫(yī)院2011年到2013年臨床分離鮑曼不動(dòng)桿菌的臨床分布特征及其對(duì)常見(jiàn)抗菌藥物的耐藥性變化。近年來(lái)，隨著廣譜抗生素、免疫抑制劑的大量使用、侵入性醫(yī)療操作的廣泛開(kāi)展等，鮑曼不動(dòng)桿菌的臨床分離率不斷增加，且耐藥現(xiàn)象日趨嚴(yán)重，世界各地陸續(xù)出現(xiàn)了多重耐藥甚至泛耐藥鮑曼不動(dòng)桿菌，使得臨床抗感染治療成為棘手難題。隨著鮑曼不動(dòng)桿菌臨床分離率及耐藥性的不斷增加，及時(shí)準(zhǔn)確的診斷，積極的預(yù)防以及有效的抗感染治療顯得尤為重要，因此，對(duì)鮑曼不動(dòng)桿菌進(jìn)行耐藥監(jiān)測(cè)，了解其臨床分布特征，對(duì)有效治療該菌引起的感染和有效預(yù)防其在醫(yī)院的播散流行具有重要意義。各地區(qū)各醫(yī)院的氣候環(huán)境、設(shè)備條件、治療措施等不同，鮑曼不動(dòng)桿菌的感染情況及耐藥性、感染特點(diǎn)等也有所不同，為此，本文采用回顧性分析方法統(tǒng)計(jì)分析2011年至2013年我院住院患者送檢標(biāo)本中分離的鮑曼不動(dòng)桿菌的標(biāo)本來(lái)源、臨床分布特征和耐藥性變化，為指導(dǎo)臨床合理選擇使用抗菌藥物提供重要依據(jù)，并且為有效預(yù)防和減少鮑曼不動(dòng)桿菌引起的院內(nèi)感染及播散流行提供幫助。 方法 收集吉林大學(xué)中日聯(lián)誼醫(yī)院2011年至2013年期間臨床各科室送檢住院患者的各類標(biāo)本，嚴(yán)格按照《全國(guó)臨床檢驗(yàn)操作規(guī)程》的要求培養(yǎng)分離菌株，所有分離菌株應(yīng)用MicroScan WalkAway96自動(dòng)化微生物鑒定儀鑒定到種，同時(shí)進(jìn)行藥物敏感性試驗(yàn)。按2013年版美國(guó)臨床和實(shí)驗(yàn)室標(biāo)準(zhǔn)協(xié)會(huì)（CLSI）標(biāo)準(zhǔn)判讀藥敏試驗(yàn)結(jié)果。使用WHONET5.6軟件進(jìn)行統(tǒng)計(jì)分析。 結(jié)果 1.鮑曼不動(dòng)桿菌占臨床分離革蘭氏陰性菌比例 2011年我院臨床共分離革蘭氏陰性菌2035株，其中鮑曼不動(dòng)桿菌291株，占14.3%；2012年我院臨床共分離革蘭氏陰性菌3103株，其中鮑曼不動(dòng)桿菌424株，占13.7%；2013年我院臨床共分離革蘭氏陰性菌2995株，其中鮑曼不動(dòng)桿菌301株，占10.1%。 2.鮑曼不動(dòng)桿菌的標(biāo)本構(gòu)成 2011年至2013年臨床分離鮑曼不動(dòng)桿菌共1016株，其中痰標(biāo)本分離該菌734株，占總分離率的72.2%；膿汁分泌物分離該菌190株，占總分離率的18.7%；尿標(biāo)本分離該菌21株，占總分離率的2.1%；血培養(yǎng)標(biāo)本分離該菌25株，占總分離率的2.5%；其他類型標(biāo)本分離該菌46株，占總分離率的4.5%。分離出鮑曼不動(dòng)桿菌的主要標(biāo)本類型為痰標(biāo)本，超過(guò)50%，其次為膿汁分泌物。 3.鮑曼不動(dòng)桿菌的臨床分布特征 我院臨床科室中鮑曼不動(dòng)桿菌分離率最高的為神經(jīng)外科，神經(jīng)外科2011年至2013年分離的鮑曼不動(dòng)桿菌占臨床總分離率分別為45.0%、32.3%、32.9%；神經(jīng)外科分離的鮑曼不動(dòng)桿菌主要來(lái)源于痰標(biāo)本，所占比例三年均接近90%，且分析結(jié)果顯示神經(jīng)外科分離的鮑曼不動(dòng)桿菌耐藥現(xiàn)象更為嚴(yán)重，其他該菌分離率較高的科室還有骨科、呼吸內(nèi)科、胸外科、ICU病房、心內(nèi)科、神經(jīng)內(nèi)科、腫瘤血液科以及肝膽胰外科等。 4.鮑曼不動(dòng)桿菌對(duì)常用抗菌藥物的耐藥性變化 對(duì)2011年至2013年我院臨床分離鮑曼不動(dòng)桿菌的耐藥性分析結(jié)果顯示，頭孢哌酮/舒巴坦為該菌耐藥率最低的抗菌藥物，2013年數(shù)據(jù)與2012年數(shù)據(jù)比較顯示鮑曼不動(dòng)桿菌對(duì)頭孢哌酮/舒巴坦耐藥率呈現(xiàn)出增加趨勢(shì)；對(duì)碳青霉烯類藥物亞胺培南2011年至2013年耐藥率分別為44.4%、48.9%、48.5%，三年耐藥率均超過(guò)40%；對(duì)四環(huán)素類藥物的耐藥率2012年為16.7%，2013年為51%，兩年數(shù)據(jù)比較顯示對(duì)四環(huán)素類藥物的耐藥率有上升趨勢(shì)；對(duì)氨基糖苷類藥物阿米卡星2011年至2103年耐藥率分別為61.2%、38.2%、35.7%，三年數(shù)據(jù)比較顯示對(duì)阿米卡星的耐藥率呈現(xiàn)出下降趨勢(shì)；對(duì)喹諾酮類藥物環(huán)丙沙星耐藥率較高，三年均超過(guò)50%，對(duì)左旋氧氟沙星的耐藥率2011年和2012年在50%左右，2013年耐藥率有所下降，為35.4%；對(duì)頭孢類抗菌藥物耐藥現(xiàn)象嚴(yán)重，三年均在50%以上，其中對(duì)頭孢噻肟耐藥現(xiàn)象最為嚴(yán)重，三年均超過(guò)90%。 5.不同類型標(biāo)本中鮑曼不動(dòng)桿菌耐藥性差別 痰標(biāo)本中鮑曼不動(dòng)桿菌對(duì)頭孢哌酮/舒巴坦耐藥率最低，其次為左旋氧氟沙星、亞胺培南。其他類型標(biāo)本中的鮑曼不動(dòng)桿菌對(duì)頭孢哌酮/舒巴坦耐藥率亦最低，，且低于痰標(biāo)本中鮑曼不動(dòng)桿菌對(duì)該抗菌藥物的耐藥率，其次耐藥率較低的是亞胺培南，且明顯低于痰標(biāo)本中鮑曼不動(dòng)桿菌對(duì)該抗菌藥的耐藥率，對(duì)阿米卡星的耐藥率要高于痰標(biāo)本中鮑曼不動(dòng)桿菌。 結(jié)論 1.鮑曼不動(dòng)桿菌占臨床分離革蘭氏陰性菌比例高。 2.鮑曼不動(dòng)桿菌檢出率最高的標(biāo)本是痰液，提示鮑曼不動(dòng)桿菌主要引起呼吸道感染。 3.神經(jīng)外科為我院臨床中鮑曼不動(dòng)桿菌分離率最高的科室，痰液為神經(jīng)外科分離的鮑曼不動(dòng)桿菌的主要標(biāo)本來(lái)源，且神經(jīng)外科分離的鮑曼不動(dòng)桿菌耐藥現(xiàn)象更為嚴(yán)重，其他該菌分離率較高的科室還有骨科、呼吸內(nèi)科、胸外科、ICU病房、心內(nèi)科、神經(jīng)內(nèi)科、腫瘤血液科以及肝膽胰外科等。 4.三年數(shù)據(jù)顯示鮑曼不動(dòng)桿菌耐藥率未呈出現(xiàn)明顯變化，目前頭孢哌酮/舒巴坦和亞胺培南仍為治療該菌所引起感染較為有效的藥物。 5.四種常見(jiàn)類型標(biāo)本所分離的鮑曼不動(dòng)桿菌耐藥率最低的藥物均為頭孢哌酮/舒巴坦，其中痰標(biāo)本中鮑曼不動(dòng)桿菌對(duì)頭孢哌酮/舒巴坦的耐藥率要高于其他類型標(biāo)本。痰標(biāo)本中鮑曼不動(dòng)桿菌對(duì)亞胺培南的耐藥率明顯高于其他類型標(biāo)本。
[Abstract]:objective
To understand the clinical distribution of Acinetobacter Bauman from 2011 to 2013 of Jilin University and the clinical distribution of Acinetobacter and the change of resistance to common antibiotics. In recent years, the clinical isolation rate of Acinetobacter Bauman has been increasing with the extensive use of broad-spectrum antibiotics, the extensive use of immunosuppressive agents and the extensive development of invasive medical operation. Multidrug-resistant and drug-resistant Acinetobacter Bauman is becoming more and more serious in the world, which makes the clinical anti infection treatment become a difficult problem. With the clinical isolation rate and increasing drug resistance of Acinetobacter Bauman, the timely and accurate diagnosis, the extreme prevention and effective anti infection treatment are particularly important. It is important, therefore, to monitor the drug resistance of Acinetobacter Bauman, to understand the clinical distribution characteristics, to effectively treat the infection caused by the bacteria and to effectively prevent the spread of the epidemic in the hospital. The climate, the equipment conditions, the treatment measures, and the infection and drug resistance of Acinetobacter Bauman in various regions, and the resistance and resistance of Acinetobacter sp. For this reason, the retrospective analysis method is used to analyze the source of the sample of Acinetobacter Bauman isolated from the hospitalized patients from 2011 to 2013, the clinical distribution characteristics and the change of drug resistance, so as to provide an important basis for guiding the rational use of anti bacteria drugs and for effective prevention and treatment. It can help reduce nosocomial infection and disseminated epidemic caused by Acinetobacter Bauman.
Method
All the specimens of the patients in the clinical departments of Jilin University from 2011 to 2013 were collected, and the isolated strains were trained strictly according to the requirements of the national clinical inspection procedure. All the isolates were identified by MicroScan WalkAway96 automated microbial identification instrument, and the drug sensitivity test was carried out at the same time. According to the 2013 edition of the American clinical and Laboratory Standards Association (CLSI) standard, the results of drug sensitivity test were analyzed. WHONET5.6 software was used for statistical analysis.
Result
1. Acinetobacter Bauman accounted for the proportion of Gram-negative bacteria isolated clinically.
In 2011, 2035 strains of Gram-negative bacteria were isolated from our hospital, of which 291 strains of Acinetobacter Bauman, which accounted for 14.3%, 3103 strains of Gram-negative bacteria were isolated in our hospital in 2012, of which 424 strains of Acinetobacter Bauman accounted for 13.7%; 2995 of Gram-negative bacteria were isolated from our hospital in 2013, of which 301 strains of Acinetobacter Bauman accounted for 10.1%..
2. specimens of Acinetobacter Bauman
From 2011 to 2013, 1016 strains of Acinetobacter Bauman were isolated, of which 734 strains were isolated from sputum specimens, accounting for 72.2% of the total separation rate, 190 strains isolated from the abscess, accounting for 18.7% of the total separation rate; 21 strains of the bacteria were isolated from the urine specimens, accounting for 2.1% of the total separation rate, and 25 strains isolated from the blood culture specimen, accounting for 2.5% of the total separation rate, and other classes. Type specimens isolated from 46 strains of bacteria, accounting for the total isolation rate of 4.5%., the main specimens of Bauman Acinetobacter were sputum specimens, more than 50%, followed by pus secretion.
Clinical distribution characteristics of 3. Acinetobacter Bauman
In the clinical department of our hospital, the highest separation rate of Acinetobacter Bauman was in the Department of neurosurgery. The total clinical isolation rate of Acinetobacter Bauman separated from 2011 to 2013 in the Department of neurosurgery was 45%, 32.3%, 32.9%, respectively. The proportion of Acinetobacter Bauman isolated mainly from sputum specimens, the proportion of which was close to 90%, and the analysis showed God. The drug resistance of Acinetobacter Bauman, which was separated by surgery, was more serious. There were Department of orthopedics, respiratory medicine, Department of thoracic surgery, ICU ward, Department of Neurology, tumor and hepatobiliary and pancreatic surgery.
4. drug resistance of Acinetobacter baumannii to commonly used antibiotics in
The drug resistance analysis of the clinical isolates of Acinetobacter Bauman from 2011 to 2013 showed that Cefoperazone / sulbactam was the lowest antibiotic drug in the bacteria. Compared with 2012 data, the drug resistance rate of Acinetobacter Bauman showed an increasing trend in the drug resistance rate of Cefoperazone / sulbactam, and the carbapenems, Ya Anpei, was compared to the 2012 data. The drug resistance rate of Cefoperazone / sulbactam showed an increasing trend; the drug resistance rate of Cefoperazone / sulbactam was increased in 2013; and the carbapenems, Ya Anpei, was the same. The resistance rates from 2011 to 2013 were 44.4%, 48.9%, 48.5% and three years, respectively, and the resistance rates were all over 40% in three years. The resistance rate to tetracycline was 16.7% in 2012 and 51% in 2013. The two years data showed that the resistance rate of tetracycline drugs increased and the resistance rate of aminoglycoside drugs Amikacin to 2103 was 61.2, respectively. The data of%, 38.2%, 35.7%, and three years showed a decline in the resistance rate of Amikacin, a high drug resistance rate to ciprofloxacin, more than 50% in three, 50% in 2011 and 2012 in Levofloxacin and 35.4% in 2013, and 35.4% for the drug resistance of cephalosporins. All of them were more than 50% in three years. Among them, the drug resistance to cefotaxime was the most serious, and all of them were over 90%. in three.
5. drug resistance of Acinetobacter baumannii in different types of specimens, Bauman
The resistance rate of Acinetobacter Bauman to Cefoperazone / sulbactam was the lowest in sputum specimens, followed by levofloxacin and imipenem. The resistance rate of Acinetobacter Bauman to Cefoperazone / sulbactam was also the lowest in other types of specimens, and was lower than that of Acinetobacter Bauman in sputum specimens. Amipenem was significantly lower than that in sputum specimens, and the resistance rate of Acinetobacter Bauman to the antibacterial drug was higher than that of Bauman's Acinetobacter in sputum specimens.
conclusion
1. Acinetobacter Bauman accounted for a high proportion of clinical isolates of gram negative bacteria.
2. the highest detection rate of Acinetobacter Bauman is sputum, suggesting that Acinetobacter Bauman mainly causes respiratory tract infection.
3. in the Department of Neurosurgery, the isolation rate of Acinetobacter Bauman was the highest in our hospital. The sputum was the main source of the specimen of Acinetobacter Bauman isolated from the Department of Neurosurgery, and the drug resistance of Acinetobacter Bauman was more serious. Department of internal medicine, neurology, tumor department of Hematology, hepatobiliary and pancreatic surgery, etc.
The data of 4. three years showed that the resistance rate of Acinetobacter Bauman did not show significant changes. At present, Cefoperazone / Shubatan and imipenem are still more effective drugs for the infection.
5. the lowest drug resistance rates of Acinetobacter Bauman isolated from four common types were Cefoperazone / sulbactam, and the resistance rate of Acinetobacter Bauman to Cefoperazone / sulbactam in sputum specimens was higher than that of other types. The resistance rate of Acinetobacter Bauman to south of Ya Anpei in sputum specimens was significantly higher than that of other types.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R446.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 許能鋒,李陽(yáng),陳娟娟,徐文體,王曉歡;醫(yī)院感染危險(xiǎn)因素病例對(duì)照研究[J];中國(guó)感染控制雜志;2005年02期

2 黃娟;謝志春;覃金愛(ài);張?jiān)?韋志福;黃小紅;;不動(dòng)桿菌醫(yī)院感染流行病學(xué)調(diào)查[J];應(yīng)用預(yù)防醫(yī)學(xué);2006年06期

3 陶傳敏;呂曉菊;李萍;;嗜麥芽窄食單胞菌對(duì)氟喹諾酮類抗菌藥的分子耐藥機(jī)制研究[J];四川大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2006年02期

4 馬艷,張淑貞;老年患者院內(nèi)肺部感染的相關(guān)危險(xiǎn)因素分析及護(hù)理對(duì)策[J];解放軍護(hù)理雜志;2002年03期

5 史俊艷;張小江;徐英春;俞云松;楊青;汪復(fù);朱德妹;倪語(yǔ)星;孫景勇;孫自鏞;簡(jiǎn)翠;胡云健;艾效曼;張泓;李萬(wàn)華;賈蓓;黃文祥;王傳清;薛建昌;魏蓮花;吳玲;卓超;蘇丹虹;張朝霞;季萍;;2007年中國(guó)CHINET鮑曼不動(dòng)桿菌耐藥性監(jiān)測(cè)[J];中國(guó)感染與化療雜志;2009年03期

6 陸文香;;ICU鮑曼不動(dòng)桿菌感染情況與耐藥分析[J];抗感染藥學(xué);2010年02期

7 程仕虎;王睿;;新一代四環(huán)素類藥物替加環(huán)素的研究進(jìn)展[J];科學(xué)技術(shù)與工程;2007年16期

8 應(yīng)春妹;翁文浩;;鮑曼不動(dòng)桿菌多重耐藥機(jī)制研究進(jìn)展[J];檢驗(yàn)醫(yī)學(xué);2007年02期

9 賀建湘;陳中芬;宋凌霞;;神經(jīng)外科鮑曼不動(dòng)桿菌感染的危險(xiǎn)因素及護(hù)理對(duì)策[J];醫(yī)學(xué)信息(中旬刊);2010年04期

10 杜銳;韓文瑜;雷連成;;金黃色葡萄球菌氟喹諾酮的耐藥性與gyrA、gyrB突變的關(guān)系研究[J];中國(guó)預(yù)防獸醫(yī)學(xué)報(bào);2006年04期

本文編號(hào)：1834369