【摘要】：目的：血流感染具有臨床癥狀重、死亡率高的特征。本研究檢測昆明醫(yī)科大學(xué)第二附屬醫(yī)院血流感染大腸埃希菌耐藥特性及耐藥基因構(gòu)成并對分布情況進(jìn)行分析；探討社區(qū)與醫(yī)院血流感染中產(chǎn)ESBLs大腸埃希菌臨床流行病學(xué)情況,并對產(chǎn)ESBLs大腸埃希菌引起血流感染的危險(xiǎn)因素進(jìn)行分析。方法：收集昆明醫(yī)科大學(xué)第二附屬醫(yī)院2014年1-12月血流感染中大腸埃希菌181株,其中社區(qū)感染88株,醫(yī)院感染93株。采用法國梅里埃VITEK-2 Compact儀器進(jìn)行細(xì)菌鑒定和藥物敏感試驗(yàn)；采用K-B紙片擴(kuò)散法檢測產(chǎn)ESBLs大腸埃希菌；對ESBLs陽性菌株CTX, TEM和SHV基因進(jìn)行PCR擴(kuò)增,明確基因分型情況。通過臨床病歷資料收集,采用SP13.0軟件對其引起血流感染的危險(xiǎn)因素進(jìn)行分析。結(jié)果：1、181株血流感染大腸埃希菌耐藥率均低于10%的有頭孢哌酮／舒巴坦、哌拉西林／他唑巴坦、厄他培南、亞胺培南、阿米卡星,醫(yī)院感染菌株耐藥率普遍高于社區(qū)感染菌株。社區(qū)血流感染產(chǎn)ESBLs大腸埃希菌檢出47株,陽性率為53.4%,醫(yī)院血流感染產(chǎn)ESBLs大腸埃希菌檢出68株,陽性率為73.1%,社區(qū)感染顯著低于醫(yī)院感染(P=0.006)。2、115株產(chǎn)ESBLs大腸埃希菌中均擴(kuò)增出CTX型基因占95%,其中CTX-M-1占35%、CTX-M-9占63%；TEM型占53%；SHV型占15%。同時(shí)攜帶2種基因的有58株占50.4%,同時(shí)攜帶3種基因的有13株占11.3%。3、在全院血流感染ESBLs大腸埃希菌檢出率前三位科室為ICU、泌尿外科和普外科,其中社區(qū)感染占57.4%,醫(yī)院感染64.7%。6項(xiàng)臨床危險(xiǎn)因素觀察指標(biāo)中,4項(xiàng)指標(biāo)結(jié)果有顯著差異,具有統(tǒng)計(jì)學(xué)意義,分別為近3個(gè)月是否入住醫(yī)療機(jī)構(gòu)、是否使用抗生素、是否留置導(dǎo)管及是否機(jī)械通氣。結(jié)論：1、昆明醫(yī)科大學(xué)第二附屬醫(yī)院社區(qū)血流感染大腸埃希菌耐藥率普遍低于醫(yī)院感染。2、產(chǎn)ESBLs大腸埃希菌流行基因型主要為CTX型,其次為TEM型和SHV型。3、ICU、泌尿外科、普外科患者血流感染產(chǎn)ESBLs大腸埃希菌陽性率高于其他科室,產(chǎn)ESBLs大腸埃希血流感染可能與醫(yī)療機(jī)構(gòu)入住、使用抗生素和侵入性操作等因素有關(guān)。故加強(qiáng)醫(yī)院感染控制,規(guī)范侵入性操作,提高醫(yī)患人員的無菌意識(shí)及手衛(wèi)生,合理使用抗生素,加強(qiáng)ICU、泌尿外科等病房的感染監(jiān)測是控制細(xì)菌耐藥性產(chǎn)生的有效措施。
[Abstract]:Objective: blood flow infection is characterized by severe clinical symptoms and high mortality. The drug resistance characteristics of Escherichia coli in the second affiliated hospital of Kunming Medical University and the composition of drug resistance gene were detected and the distribution was analyzed. To investigate the clinical epidemiology of ESBLs Escherichia coli in community and hospital, and to analyze the risk factors of blood stream infection caused by ESBLs producing Escherichia coli. Methods: 181 strains of Escherichia coli from January to December 2014 in the second affiliated Hospital of Kunming Medical University were collected, including 88 strains of community infection and 93 strains of nosocomial infection. The bacteria identification and drug sensitivity test were carried out by using the Merier VITEK-2 Compact instrument in France, the ESBLs producing Escherichia coli was detected by K-B disk diffusion method, and the CTX, TEM and SHV genes of ESBLs positive strains were amplified by PCR to determine the genotyping. The risk factors of blood flow infection were analyzed by SP13.0 software. Results: the drug resistance rates of 1181 blood stream infected Escherichia coli strains were less than 10%, including cefoperazone / sulbactam, piperacillin / tazobactam, etapenem, imipenem, amikacin, etc. The drug resistance rate of nosocomial infection strains was higher than that of community infection strains. 47 strains of ESBLs producing Escherichia coli were detected from community blood flow infection, the positive rate was 53.4%, and 68 strains from hospital blood stream infection produced ESBLs Escherichia coli, the positive rate was 73.1%. Community infection was significantly lower than nosocomial infection (P0. 006). In 2115 strains of ESBLs producing Escherichia coli, 95% of the CTX genes were amplified, of which CTX-M-1 accounted for 35% and CTX-M-9 accounted for 63%. The TEM type was 53% and the SHV type was 15%. There were 58 strains (50.4%) carrying two genes and 13 strains (11.3.3%) carrying three genes simultaneously. ICU, urology and general surgery were the first three departments in the detection rate of ESBLs Escherichia coli infection in the whole hospital. Among them, 57.4% were community infection, 64.7.6 clinical risk factors were observed in hospital infection, and there were significant differences among the four indexes, which were whether or not they were admitted to medical institutions in the last 3 months. Do you use antibiotics, catheters, and mechanical ventilation? Conclusion: 1. The drug resistance rate of Escherichia coli in community blood stream infection of the second affiliated hospital of Kunming Medical University was generally lower than that of nosocomial infection. 2. The prevalent genotype of ESBLs producing Escherichia coli was CTX, followed by TEM and SHV. The positive rate of ESBLs producing Escherichia coli in patients with blood flow infection in urology and general surgery was higher than that in other departments. The infection of ESBLs might be related to the medical institutions, antibiotics use and invasive operation and so on. Therefore, strengthening hospital infection control, standardizing invasive operation, improving staff's aseptic consciousness and hand hygiene, rational use of antibiotics, and strengthening infection monitoring in ICU, urology ward are effective measures to control bacterial drug resistance.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R446.5

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