【摘要】：目的：現(xiàn)使用Meta分析的方法,通過查找收集相關(guān)課題的研究文獻對我國碳青霉烯類抗菌藥物耐藥的腸桿菌科細(xì)菌(CRE)的耐藥機制進行概括統(tǒng)計分析；探討現(xiàn)有各類CRE檢測方法的優(yōu)缺點及靈敏度和特異度的可靠性；對國內(nèi)醫(yī)院外科系統(tǒng)感染現(xiàn)狀進行循證醫(yī)學(xué)評價,綜合全面的了解我國CRE感染流行及相關(guān)疾病的檢出控制狀況。方法：計算機檢索PubMed、wanFang Data、VIP、CNKI、The cochrane Library、 EMbase及CBM數(shù)據(jù)庫,將檢索時限定為從1994年開始至2014年12月為止,篩選后進行統(tǒng)計及Meta分析。結(jié)果：共納入對CRE耐藥機制研究相關(guān)文獻37篇,共研究分析了我國各地區(qū)14個省累積為1081株CRE菌株。顯示：菌種前三位是肺炎克雷伯菌、大腸埃希菌、陰溝腸桿菌；比較淮河以南和淮河以北的CRE的相關(guān)耐藥基因顯示：目前在我國出現(xiàn)的CRE菌株主要為產(chǎn)生碳青霉烯酶,以KPC酶為首；其次是外膜蛋白的數(shù)量減少或缺失伴由染色體或質(zhì)粒介導(dǎo)持續(xù)產(chǎn)生高水平β-內(nèi)酰胺酶。對有關(guān)CRE診斷方法研究,最終納入文獻16篇(中文10篇,英文6篇)。分析顯示：(1)改良Hodge試驗作為檢測CRE菌株的初步篩選試驗。(2)CHROMagarTM KPC檢測培養(yǎng)皿法：合并特異度及敏感度均不高,但最大的優(yōu)點為檢測方法簡便。(3)美羅培南和APBA(3-氨基苯硼酸)聯(lián)合KPC表型檢測：該法操作簡單,并提供了客觀的判斷標(biāo)準(zhǔn),結(jié)果清晰易讀,且經(jīng)現(xiàn)有研究表明其檢測KPC的靈敏度與特異度均為10096。國內(nèi)綜合醫(yī)院感染現(xiàn)狀研究的相關(guān)文獻共納入87篇。統(tǒng)計分析：綜合醫(yī)院院內(nèi)感染占內(nèi)外科室病患的百分比發(fā)現(xiàn),外科體系感染患病機率稍高；月份以9-11月期間醫(yī)院感染率較高；感染部位以呼吸道、泌尿道、血液為三大易感部位；醫(yī)院感染檢出致病菌種類及構(gòu)成顯示,G-桿菌仍占檢出菌一半以上；真菌感染比率有逐年上升趨勢。
[Abstract]:Objective: to analyze the drug resistance mechanism of Enterobacteriaceae bacteria (CRE) which is resistant to carbapenems by using the method of Meta analysis. To investigate the advantages and disadvantages, sensitivity and specificity of the existing CRE detection methods, to evaluate the present situation of hospital surgical system infection in China by evidence-based medicine, and to comprehensively understand the detection and control of CRE infection and related diseases in China. Methods: the cochrane Library, EMbase and CBM databases of PubMedwan Fang data VIPI were searched by computer. The search time was limited from 1994 to December 2014. After screening, the data were statistically analyzed and analyzed by Meta. Results: a total of 37 articles on the mechanism of drug resistance of CRE were included. The cumulative number of CRE strains in 14 provinces of China was 1081. The results showed that the first three strains were Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae. The second was the decrease or deletion of outer membrane protein and the continuous production of high level 尾 -lactamases mediated by chromosomes or plasmids. 16 articles (10 in Chinese and 6 in English) were included in the study on the diagnostic methods of CRE. The results showed that: (1) the modified Hodge test was used as a preliminary screening test for the detection of CRE strains. (2) CHROMagarTM KPC assay for petri dishes: the combined specificity and sensitivity were not high. But the biggest advantage is that the detection method is simple. (3) meropenem and APBA (3-aminophenoboric acid) combined with KPC phenotype detection: this method is simple to operate and provides an objective judgment standard, the results are clear and easy to read. The sensitivity and specificity of KPC were 100 96. A total of 87 articles were included in the study on the current situation of general hospital infection in China. Statistical analysis: the percentage of nosocomial infection in general hospital patients in internal and external departments showed that the incidence of infection in surgical system was slightly higher; the nosocomial infection rate was higher between September and November; the infection site was respiratory tract, urinary tract, respiratory tract and urinary tract. The blood was the three most susceptible sites, the species and composition of pathogenic bacteria detected in hospital infection showed that G- bacillus still accounted for more than half of the detected bacteria, and the rate of fungal infection was increasing year by year.
【學(xué)位授予單位】：蘭州大學(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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