發(fā)布時間：2018-06-13 01:46

  本文選題：臨床 + 病原菌��； 參考：《山東大學(xué)》2015年碩士論文

【摘要】：研究目的1.研究聊城地區(qū)某醫(yī)院臨床分離到的主要病原菌的構(gòu)成比及分布特征,主要包括性別、年齡、標(biāo)本種類和科室等方面的分布狀況。2.了解產(chǎn)酶(ESBLs)的大腸埃希菌和肺炎克雷伯菌以及耐甲氧西林金黃色葡萄球菌的檢出率。3.比較主要的革蘭氏陰性桿菌在不同組別的耐藥率。4.分析主要病原菌對常用抗菌藥物的耐藥率。5.分別比較肺炎克雷伯菌和大腸埃希菌產(chǎn)酶(ESBLs)菌株與非產(chǎn)酶(ESBLs)菌株對常用抗菌藥物的耐藥率。6.比較耐甲氧西林金黃色葡萄球菌(MRSA)與甲氧西林敏感金黃色葡萄球菌(MSSA)的耐藥率7.了解主要病原菌對常用抗菌藥物耐藥率的變遷。研究方法1.標(biāo)本收集：收集聊城地區(qū)某院2011年5月—2014年5月臨床送檢的各類標(biāo)本,包括痰、尿、傷口分泌物以及血液等標(biāo)本中分離的位居前五位的主要病原菌,然后對其進(jìn)行研究分析,菌株都是選取患者首次分離的菌株。2.實(shí)驗(yàn)室檢測2.1 菌株鑒定：嚴(yán)格按照《全國臨床檢驗(yàn)操作規(guī)程》進(jìn)行細(xì)菌的分離和鑒定,細(xì)菌的鑒定采用法國生物梅里埃公司提供的Vitek2-compact全自動微生物鑒定儀器。標(biāo)準(zhǔn)菌株有：肺炎克雷伯菌ATCC700603、大腸埃希菌ATCC25922、銅綠假單胞菌ATCC27853、金黃色葡萄球菌ATCC25923,標(biāo)準(zhǔn)菌株購買于山東省臨床檢驗(yàn)中心。2.2藥敏試驗(yàn)：2.2.1病原菌對常用抗菌藥物的耐藥性檢測采用Vitek2-compact全自動微生物鑒定系統(tǒng)配套的藥敏鑒定卡。2.2.2超廣譜p-內(nèi)酰胺酶(ESBLs)和耐甲氧西林金黃色葡萄球菌(MRSA)的檢測依據(jù)2010年美國臨床實(shí)驗(yàn)室標(biāo)準(zhǔn)化研究所(CLSI)的標(biāo)準(zhǔn)進(jìn)行抗菌藥物敏感性判斷。3.統(tǒng)計(jì)學(xué)分析：數(shù)據(jù)的統(tǒng)計(jì)分析采用Whonet5.6和SPSS16.0兩種軟件,采用卡方檢驗(yàn)或fisher確切概率法對不同耐藥率進(jìn)行比較,P0.05認(rèn)為有統(tǒng)計(jì)學(xué)意義。研究結(jié)果1.聊城地區(qū)某院2011年5月-2014年5月臨床分離的前五位的主要病原菌共1292株。其中以革蘭氏陰性桿菌為主,占86.8%,革蘭氏陰性桿菌依次為肺炎克雷伯菌31.1%、大腸埃希菌27.9%、銅綠假單胞菌16.0%和鮑曼不動桿菌11.8%；前五位中唯一的一種革蘭氏陽性菌是金黃色葡萄球菌,占13·2%。2.病原菌從年齡和性別分布來看,65歲的老年人占60.1%,男女之比為1.4：1；從標(biāo)本分布來看,主要以痰液為主,占65.9%,其次是尿液和膿液分別為11.1%、11.3%；從科室分布來看,病原菌在重癥監(jiān)護(hù)病房的檢出率為39.5%,內(nèi)科病房與外科病房分別為27.3%和26.1%。3.產(chǎn)ESBLs的肺炎克雷伯菌和大腸埃希菌的菌株檢出率分別為39.1%、60.6%,二者三年總體均呈下降趨勢。耐甲氧西林金黃色葡萄球菌檢出率為42.4%。4.革蘭氏陰性桿菌對阿米卡星、亞胺培南和哌拉西林/他唑巴坦的耐藥率都20%：而對單環(huán)類抗生素氨曲南、青霉素類氨芐西林和第一代頭孢唑啉、二代頭孢呋辛和三代頭孢曲松、頭孢他啶的耐藥率都大于30%。亞胺培南在所有組別中的耐藥率最低,為0-7.5%之間,而氨芐西林在所有組別中的耐藥率卻是最高的,大約在72.2%-89.6%之間。產(chǎn)ESBLs酶與非產(chǎn)ESBLs酶的菌株比較,除亞胺培南、阿米卡星和復(fù)方新諾明外,二者對其它抗菌藥物都有顯著性差異,具有統(tǒng)計(jì)學(xué)意義(P0.05)。金黃色葡萄球菌對萬古霉素、利奈唑胺和替加環(huán)素耐藥率為0,,對呋喃妥因的耐藥率比較低,僅為0.6%,對其余幾種抗菌藥物的耐藥率大約在30-60%之間。5.肺炎克雷伯菌僅對呋喃妥因、氨芐西林／舒巴坦、頭孢呋辛、頭孢曲松和頭孢他啶三年的耐藥率變化有統(tǒng)計(jì)學(xué)意義(P0.05),大腸埃希菌除對頭孢吡肟、頭孢呋辛和頭孢他啶三種抗菌藥物的耐藥率變化有統(tǒng)計(jì)學(xué)意義(P0.05)外,二者對其余的抗菌藥物的耐藥率變化均無統(tǒng)計(jì)學(xué)意義(P0.05)。鮑曼不動桿菌對抗菌藥物的耐藥率變化趨勢大多數(shù)呈上升的趨勢。雖然銅綠假單胞菌對氨芐西林／舒巴坦、呋喃妥因、復(fù)方新諾明、頭孢曲松、頭孢他啶、頭孢呋辛的耐藥率變化不大,但是耐藥率一直呈現(xiàn)很高的狀態(tài),而阿米卡星的耐藥率變化較大,由16.7%下降到0,較明顯(P0.05)。金黃色葡萄球菌三年對替加環(huán)素、萬古霉素和利奈唑胺的耐藥率一直為零,除對復(fù)方新諾明的耐藥率呈上升的趨勢外(P0.05),對其他幾種抗菌藥物的耐藥率呈直線下降,三年比較具差異有統(tǒng)計(jì)學(xué)意義(P0.05)。研究結(jié)論1.聊城地區(qū)臨床分離的病原菌主要是革蘭氏陰性桿菌,其次是革蘭氏陽性球菌；位居前五位的分別為肺炎克雷伯菌、大腸埃希菌、銅綠假單胞菌、金黃色葡萄球菌和鮑曼不動桿菌。2.五種病原菌的分布從患者來看,主要是65歲的老年男性患者;從標(biāo)本分布來看,主要以痰夜為主,其次是尿液和膿液;從科室分布來看,以重癥監(jiān)護(hù)病房為主,其次是內(nèi)科病房和外科等病房。3.聊城地區(qū)大腸埃希菌和肺炎克雷伯菌產(chǎn)超廣譜β-內(nèi)酰胺酶(ESBLs)的現(xiàn)象仍然很嚴(yán)重,并且耐甲氧西林金黃色葡萄球菌在該地區(qū)的存在也應(yīng)引起足夠的重視。4.革蘭氏陰性桿菌對碳青霉烯類抗生素亞胺培南、p-內(nèi)酰胺類／酶抑制劑復(fù)合劑哌拉西林／他唑巴坦和阿米卡星耐藥率較低,而對單環(huán)類抗生素、青霉素類和頭孢類一、二、三代的抗生素耐藥率比較高；亞胺培南在所有組別中的耐藥率最低,而氨芐西林在所有組別中的耐藥率卻是最高的。產(chǎn)ESBLs菌株的耐藥率明顯高于非產(chǎn)ESBLs菌株。雖然革蘭氏陽性金黃色葡萄球菌沒有發(fā)現(xiàn)對萬古霉素、利奈唑胺和替加環(huán)素耐藥的菌株,但對其它抗菌藥物卻呈現(xiàn)不同的耐藥性。5.肺炎克雷伯菌和大腸埃希菌的三年的耐藥率變化不明顯,而鮑曼不動桿菌的耐藥率變化總體上呈上升趨勢,銅綠假單胞菌的耐藥率變化不大,但是一直呈現(xiàn)很高的狀態(tài),金黃色葡萄球菌的耐藥率變化呈下降的趨勢。
[Abstract]:Objective 1. to study the composition and distribution characteristics of the main pathogenic bacteria isolated from a hospital in Liaocheng, including the distribution of sex, age, specimen type and department, and so on. The detection rate of Escherichia coli and Klebsiella pneumoniae and methicillin resistant Staphylococcus aureus in Liaocheng was compared with the detection rate of.3.. The resistance rate of the main gram negative bacilli in different groups.4. analysis of the resistance rate of the main pathogens to common antibiotics.5. compared the resistance rate of Klebsiella pneumoniae and Escherichia coli (ESBLs) and non productive enzyme (ESBLs) to common antimicrobial agents compared with.6., methicillin resistant Staphylococcus aureus (MRSA) and a The resistance rate of oxicillin sensitive Staphylococcus aureus (MSSA) 7. to understand the changes in the rate of resistance of the main pathogens to common antibiotics. Methods 1. specimens were collected: collection of specimens from a hospital in Liaocheng from May 2011 to May 2014, including the top five of the specimens, including sputum, urine, wound secretions, and blood. The main pathogenic bacteria were studied and analyzed. The strains were identified by the strain.2. laboratory test for the first time isolated by the patient: strictly according to the national clinical inspection procedure for bacterial isolation and identification, and the identification of the bacteria was used by the Vitek2-compact fully automatic microorganism provided by the French biological merier company. Identification instruments. The standard strains are: Klebsiella pneumoniae ATCC700603, Escherichia coli ATCC25922, Pseudomonas aeruginosa ATCC27853, Staphylococcus aureus ATCC25923, the standard strain purchased in Shandong clinical laboratory center.2.2 drug sensitivity test: 2.2.1 pathogenic bacteria on common antibacterial drug resistance detection using Vitek2-compact fully automatic Microbiology The detection of.2.2.2 hyper broad-spectrum p- lactamase (ESBLs) and methicillin resistant Staphylococcus aureus (MRSA) based on the identification system of physical identification system is based on the criteria of the American clinical laboratory standardization institute (CLSI) in 2010 to conduct a.3. statistical analysis of antimicrobial susceptibility: the statistical analysis of the data uses Whonet5.6 and SPSS16.0. Two kinds of software, using the chi square test or the Fisher exact probability method to compare the different drug resistance rates, P0.05 believed that there were statistical significance. 1. the main pathogens of the first five clinical isolates in a hospital in Liaocheng in May 2011, May, were mainly Gram-negative bacteria, 86.8%, and gram-negative bacilli. Klebsiella pneumoniae 31.1%, Escherichia coli 27.9%, Pseudomonas aeruginosa 16% and Acinetobacter Bauman 11.8%; the only one of the first five Gram-positive bacteria is Staphylococcus aureus, accounting for 13. 2%.2. pathogens from age and sex distribution, 65 years old people account for 60.1%, and the ratio of men and women is 1.4:1; from specimen distribution, the host In the case of sputum, 65.9%, followed by urine and pus were 11.1%, 11.3%, respectively. The detection rate of pathogenic bacteria in intensive care unit was 39.5%, and the detection rates of Klebsiella pneumoniae and Escherichia coli in medical wards and surgical wards of 27.3% and 26.1%.3. respectively were 39.1%, 60.6% and two, respectively, three years, respectively. The overall detection rate of methicillin resistant Staphylococcus aureus was 20% of 42.4%.4. gram-negative bacilli against Amikacin, imipenem and piperacillin / tazobactam, while mono antibiotics amamethanone, penicillin ampicillin and first generation cefazolin, two generation cefuroxime and three generation cephalosporin. The drug resistance rate of ceftazidime was greater than that of 30%. imipenem in all groups, with the lowest resistance rate in all groups, between 0-7.5%, and ampicillin in all groups was the highest, about 72.2%-89.6%. Compared with the strains of ESBLs and non producing ESBLs enzymes, the two groups were compared with amipenem, Amikacin and compound sulfamethoxamine. There were significant differences in other antimicrobial agents (P0.05). The resistance rate of Staphylococcus aureus to vancomycin, linezolid and tenacycline was 0, and the resistance rate to furacytine was low, only 0.6%. The resistance rate of the other kinds of antibiotics was about 30-60% between.5. pneumonia and carbofurein and ammonia only. The resistance rates of benzicillin / Shubatan, cefuroxime, ceftriaxone and ceftazidime for three years were statistically significant (P0.05). The resistance rates of Escherichia coli to cefepime, cefuroxime and ceftazidime were statistically significant (P0.05), and the changes in the rate of resistance to the remaining antibiotics were not statistically significant (P0.05). Learning significance (P0.05). The trend of the change in the resistance rate of Acinetobacter Bauman to antibiotics was most rising. Although Pseudomonas aeruginosa had little change in the rate of ampicillin / Shubatan, furadetin, compound Sulfamethoxine, ceftriaxone, ceftazidime and cefuroxime, the rate of drug resistance had been very high, but the rate of drug resistance had been very high, but Amie The resistance rate of card stars changed from 16.7% to 0 (P0.05). The resistance rate of Staphylococcus aureus to tetracycline, vancomycin and linezolid remained zero for three years, except for the increasing trend of resistance to compound sulfamethamine (P0.05). The resistance rate to several other kinds of antibiotics decreased in a straight line and was worse in three years. There were statistical significance (P0.05). Conclusion 1. the main pathogens isolated in Liaocheng area were gram-negative bacilli and gram-positive coccus, and the top five were the five pathogens of Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter Bauman.2.. In the case of 65 years old male patients, the main results were sputum night, followed by urine and pus; from the section of the Department, the intensive care unit was mainly in the intensive care unit, and the second was the Escherichia coli and Klebsiella pneumoniae in the.3. Liaocheng area of the internal medicine ward and the surgical ward. The phenomenon of the broad-spectrum beta lactamase (ESBLs) was produced in the medical ward and the surgical ward. Still very serious, and the presence of methicillin resistant Staphylococcus aureus in this area should also cause enough attention to.4. gram-negative bacilli to carbapenem imipenem, p- lactam / enzyme inhibitor complex piperazol / tazobactam and Amikacin resistance rates lower, and mono antibiotics, Penicillium, and Penicillium. The resistance rate of antibiotics and cephalosporins was higher in one, two and three generations; imipenem was the lowest in all groups, but the resistance rate of ampicillin was the highest in all groups. The resistance rate of the ESBLs producing strain was significantly higher than that of the non producing ESBLs strain. However, the resistance rate of Klebsiella pneumoniae and Escherichia coli of.5. was not obvious in three years, but the resistance rate of Acinetobacter Bauman showed a rising trend in general, and the resistance rate of Pseudomonas aeruginosa changed little, but it was always present. In a very high state, the resistance rate of Staphylococcus aureus showed a decreasing trend.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R446.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前6條

1 糜祖煌;秦玲;;肺炎克雷伯菌耐藥基因近年國內(nèi)研究進(jìn)展[J];現(xiàn)代實(shí)用醫(yī)學(xué);2009年01期

2 胡付品;朱德妹;汪復(fù);蔣曉飛;楊青;徐英春;張小江;孫自鏞;陳中舉;王傳清;王愛敏;倪語星;孫景勇;俞云松;林潔;單斌;杜艷;徐元宏;沈繼錄;張泓;孔菁;卓超;蘇丹虹;張朝霞;季萍;胡云建;艾效曼;黃文祥;賈蓓;魏蓮花;吳玲;;2011年中國CHINET細(xì)菌耐藥性監(jiān)測[J];中國感染與化療雜志;2012年05期

3 黃輝;陳穎;安如俊;周建黨;樊云蓉;陳波;;MRSA中mecA及femB基因的檢測與耐藥相關(guān)性[J];微生物學(xué)雜志;2009年03期

4 周博鋒;唐蘭艷;何本進(jìn);姚人業(yè);;老年醫(yī)院肺炎克雷伯菌產(chǎn)AmpC酶和ESBLs的檢測及耐藥性分析[J];右江醫(yī)學(xué);2010年05期

5 金少鴻,馬越;國內(nèi)細(xì)菌耐藥性監(jiān)測研究的回顧與展望[J];中國抗生素雜志;2005年05期

6 趙金輝;程向芳;;310株大腸埃希菌臨床分布特征及耐藥性分析[J];中國衛(wèi)生檢驗(yàn)雜志;2013年03期

，

本文編號：2012088