本文選題：社區(qū)獲得 + 血流感染　； 參考：《浙江大學(xué)》2015年碩士論文

【摘要】：目的 明確社區(qū)發(fā)作血流感染ESBLs發(fā)生率、危險(xiǎn)因素及基因型分布,評(píng)價(jià)針對(duì)產(chǎn)ESBLs細(xì)菌感染臨床常用抗菌藥物療效。 方法 收集浙江大學(xué)附屬邵逸夫醫(yī)院2013年9月11日至2014年11月30日社區(qū)獲得血培養(yǎng)為大腸埃希菌或肺炎克雷伯菌的病例共54例,測(cè)定其中22株產(chǎn)ESBLs菌株對(duì)13種抗菌藥物的敏感性；通過(guò)聚合酶鏈反應(yīng)確定產(chǎn)ESBLs菌株基因分布情況,并對(duì)患者的臨床資料進(jìn)行分析。 結(jié)果 社區(qū)獲得血流感染大腸埃希菌及肺炎克雷伯菌產(chǎn)ESBLs分別為51.3%,13.3%；年齡為本研究明確的危險(xiǎn)因素；22株產(chǎn)ESBLs菌株基因型提示共4株僅產(chǎn)1種β-內(nèi)酰胺酶,余18株同時(shí)攜帶兩種或兩種以上基因型。主要基因型為CTX-M-9,其中以CTX-M-14最常見(jiàn)。22株產(chǎn)ESBLs菌株的藥敏結(jié)果提示碳青霉烯類敏感性高,第三、四代頭孢菌素及喹諾酮類耐藥率高。臨床上不同抗菌藥物對(duì)產(chǎn)ESBLs菌株感染患者的轉(zhuǎn)歸差別明顯,其中碳青霉烯類成功率最高,其次為酶抑制劑的復(fù)合制劑,其他類抗菌藥包括喹諾酮、第三代頭孢菌素?zé)o成功案例。 結(jié)論 社區(qū)獲得血流感染產(chǎn)ESBLs大腸埃希菌流行情況嚴(yán)峻,年齡是大腸埃希菌和肺炎克雷伯菌產(chǎn)ESBLs的危險(xiǎn)因素。碳青霉烯類對(duì)產(chǎn)ESBLs的肺炎克雷伯菌和大腸埃希菌具有強(qiáng)大的抗菌活性,其次為p內(nèi)酰胺酶抑制劑復(fù)合制劑,這與臨床各類抗菌藥物療效基本相一致。ESBLs基因型主要以cTX-M-14為主,及時(shí)監(jiān)測(cè)社區(qū)產(chǎn)ESBLs菌的檢出率及其耐藥情況對(duì)指導(dǎo)臨床診療十分重要。
[Abstract]:Purpose To determine the incidence, risk factors and genotype distribution of ESBLs in community, and to evaluate the efficacy of common antimicrobial agents against ESBLs bacterial infection. Method From September 11, 2013 to November 30, 2014, 54 patients with Escherichia coli or Klebsiella pneumoniae were collected from the hospital of run Shaw, Zhejiang University. The sensitivity of 22 strains producing ESBLs to 13 antimicrobial agents was determined. The gene distribution of ESBLs producing strain was determined by polymerase chain reaction (PCR), and the clinical data of the patients were analyzed. Result The ESBLs produced by Escherichia coli and Klebsiella pneumoniae were 51.3 and 13.3, respectively, and the genotype of 22 strains of ESBLs, which was the risk factor in this study, suggested that 4 strains produced only one 尾 -lactamase. The remaining 18 strains carried two or more genotypes at the same time. The main genotypes were CTX-M-9. The drug sensitivity of 22 strains of ESBLs producing CTX-M-14 showed that carbapenem was highly sensitive and the third and fourth generation cephalosporins and quinolones were highly resistant. The clinical outcome of different antimicrobial agents on ESBLs producing strains was significantly different. The success rate of carbapenem was the highest, followed by the compound preparation of enzyme inhibitors, other antimicrobial agents including quinolone, and the third generation cephalosporins had no successful cases. Conclusion The prevalence of ESBLs producing Escherichia coli in community was severe and age was the risk factor of ESBLs production by Escherichia coli and Klebsiella pneumoniae. Carbapenems have strong antibacterial activity against Klebsiella pneumoniae and Escherichia coli producing ESBLs, followed by p-lactamases inhibitor complex, which is basically consistent with the clinical efficacy of various antimicrobial agents. CTX-M-14 is the main genotype of carbapenem. It is very important to monitor the detection rate and drug resistance of ESBLs producing bacteria in community.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R446.5

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本文編號(hào)：1907986