本文選題：銅綠假單胞菌　切入點(diǎn)：耐藥率　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:1、觀察廣西醫(yī)科大學(xué)第一附屬醫(yī)院2013年12月~2014年4月檢驗(yàn)科細(xì)菌實(shí)驗(yàn)室從住院患者各類標(biāo)本中分離培養(yǎng)出的銅綠假單胞菌菌株的來源分布及耐藥情況。2、了解該院銅綠假單胞菌菌株之間的親緣關(guān)系。3、對(duì)比銅綠假單胞菌的隨機(jī)擴(kuò)增多態(tài)性DNA(Random amplified polymorphic DNA,RAPD)指紋圖譜,判斷是否存在局部爆發(fā)流行。4、了解銅綠假單胞菌在長(zhǎng)期持續(xù)感染過程中的RAPD指紋圖譜變化情況。方法:1、收集廣西醫(yī)科大學(xué)第一附屬醫(yī)院2013年12月~2014年4月檢驗(yàn)科細(xì)菌實(shí)驗(yàn)室從本院住院患者痰液、肺泡灌洗液、血液、尿液、創(chuàng)面分泌物等各類標(biāo)本中分離培養(yǎng)出的銅綠假單胞菌菌株及其相關(guān)信息。用VITEK-2全自動(dòng)細(xì)菌鑒定/藥敏分型儀或ATB expression半自動(dòng)細(xì)菌鑒定儀對(duì)分離培養(yǎng)出的銅綠假單胞菌菌株進(jìn)行培養(yǎng)鑒定和藥敏分析。細(xì)菌培養(yǎng)鑒定和藥敏實(shí)驗(yàn)遵照《全國(guó)臨床檢驗(yàn)操作規(guī)程》的要求進(jìn)行,同時(shí)參照美國(guó)臨床和實(shí)驗(yàn)室標(biāo)準(zhǔn)協(xié)會(huì)(Clinical and Laboratory Standards Institute,CLSI)2012年制定的標(biāo)準(zhǔn)。分析非重復(fù)銅綠假單胞菌的流行病學(xué)特征及其藥敏情況。2、選擇感染銅綠假單胞菌時(shí)間大于30天的患者,從他們的痰液、肺泡灌洗液、血液、尿液等標(biāo)本中分離的銅綠假單胞菌菌株作為本實(shí)驗(yàn)的實(shí)驗(yàn)菌株。用煮沸法提取細(xì)菌基因組DNA,采用RAPD基因分型技術(shù)獲得RAPD指紋圖譜,并進(jìn)行同源性聚類分析,通過相似性系數(shù)了解該院銅綠假單胞菌菌株之間的親緣關(guān)系;對(duì)比銅綠假單胞菌的RAPD指紋圖譜,判斷銅綠假單胞菌局部爆發(fā)流行的存在,以及長(zhǎng)期持續(xù)感染銅綠假單胞菌的過程中,其指紋圖譜是否會(huì)發(fā)生改變。結(jié)果:1、共收集銅綠假單胞菌293株。其中剔除同一患者同一部位重復(fù)分離菌株后的非重復(fù)銅綠假單胞菌為175株。從標(biāo)本來源來看,非重復(fù)銅綠假單胞菌主要分離于患者的呼吸道標(biāo)本痰及肺泡灌洗液,占52%(91/175),其余依次為創(chuàng)面分泌物占18.9%(33/175)、尿液占6.9%(12/175)、血液占6.3%(11/175)、腹腔引流液占5.7%(10/175),其余標(biāo)本來自留置導(dǎo)管、咽拭子、組織標(biāo)本等。從科室分布來看,非重復(fù)銅綠假單胞菌主要分離于來自重癥監(jiān)護(hù)病房的患者,占25.7%(45/175),其次為燒傷整形外科17.7%(31/175)、中醫(yī)科占13.1%(23/175)、呼吸內(nèi)科占8.6%(15/175)和兒科5.1%(9/175),其余標(biāo)本來自其他臨床科室。分析其藥敏情況,發(fā)現(xiàn)非重復(fù)銅綠假單胞菌對(duì)氨曲南、環(huán)丙沙星、左氧氟沙星、妥布霉素及慶大霉素的耐藥率較高,均30%。2、在收集的293株銅綠假單胞菌中,有117株來自感染銅綠假單胞菌持續(xù)時(shí)間大于30天的患者;這117株銅綠假單胞菌共擴(kuò)增出19種不同的基因型條帶,分別為a~s型,分型率100%。重癥監(jiān)護(hù)病房及燒傷整形外科各發(fā)生一起在不同患者之間檢出相同rapd型別銅綠假單胞菌菌株的情況,其余患者rapd型別各不相同。有4例長(zhǎng)期持續(xù)感染銅綠假單胞菌的患者,從其痰液、肺泡灌洗液、創(chuàng)面分泌物、血液、尿液等標(biāo)本中分離培養(yǎng)出的銅綠假單胞菌rapd指紋圖譜發(fā)生改變,其余19例患者痰液、肺泡灌洗液等送檢標(biāo)本中分離出的銅綠假單胞菌rapd指紋圖譜未發(fā)生改變。結(jié)論:1、銅綠假單胞菌感染主要發(fā)生在重癥監(jiān)護(hù)病房、燒傷整形外科和中醫(yī)科;它們對(duì)多種抗生素呈不同程度耐藥,其中對(duì)氨曲南、環(huán)丙沙星、左氧氟沙星、妥布霉素及慶大霉素的耐藥率均30%,而對(duì)多粘菌素b的耐藥率為0,敏感率100%。2.銅綠假單胞菌存在基因多態(tài)性,部分型別之間具有高度的同源性。3.重癥監(jiān)護(hù)病房和燒傷整形外科各發(fā)生一起銅綠假單胞菌局部爆發(fā)流行。4.銅綠假單胞菌RAPD指紋圖譜在其長(zhǎng)期持續(xù)感染的過程中部分可發(fā)生改變。
[Abstract]:Objective: 1 isolates of Pseudomonas aeruginosa strains from various specimens from hospitalized patients in the First Affiliated Hospital of Guangxi Medical University in December 2013 April ~2014 year observation laboratory laboratory source of bacterial distribution and drug resistance of.2, understanding between the hospital Pseudomonas aeruginosa strain relationship.3, random amplified polymorphic DNA comparison of Pseudomonas aeruginosa (the Random amplified polymorphic DNA, RAPD) fingerprint, to determine whether there is local outbreaks of.4, understand the Pseudomonas aeruginosa RAPD fingerprint in long-term changes during infection. Methods: 1, the First Affiliated Hospital of Guangxi Medical University during December 2013 ~2014 April test of bacteria collected from laboratory sputum of patients in this hospital, bronchoalveolar lavage lotion, blood, urine, and related information from Pseudomonas aeruginosa strains from various specimens of wound secretion by VIT. Pseudomonas aeruginosa strain EK-2 automatic bacteria identification / drug sensitive type instrument or ATB expression semi automatic bacteria identification system for isolated culture identification and drug sensitive analysis. Bacteria identification and drug sensitive test in accordance with the "national clinical laboratory operation rules" requirements, with reference to the clinical and laboratory standards (Clinical and Laboratory Standards Institute Association, CLSI) in 2012 to develop a standard. Analysis of non repetitive Pseudomonas aeruginosa epidemiological characteristics and drug sensitivity of.2 infected Pseudomonas aeruginosa for more than 30 days in patients from their sputum, bronchoalveolar lavage fluid, blood and urine of Pseudomonas aeruginosa strains isolated. In the sample as the experimental strains. The bacterial genome DNA was extracted by boiling method, type of technology to obtain RAPD fingerprint by RAPD gene and homology through cluster analysis. A similarity coefficient of understanding the relationship between the strains of Pseudomonas aeruginosa; RAPD fingerprint comparison of Pseudomonas aeruginosa, determine the Pseudomonas aeruginosa outbreak of local existence, and the long-term sustainability of the process of infection of Pseudomonas aeruginosa, the fingerprint is not changed. The results were: 1. The collection of 293 strains of Pseudomonas aeruginosa. The patients with the same site removed the same repeat after non repeated isolates of Pseudomonas aeruginosa and 175 strains. From the specimen source, non repetitive Pseudomonas aeruginosa mainly isolated from respiratory tract specimens of sputum and lavage liquid alveolar patients, accounting for 52% (91/175), followed by the rest wound secretions accounted for 18.9% (33/175), urine accounted for 6.9% (12/175), blood accounted for 6.3% (11/175), liquid drainage accounted for 5.7% (10/175), the specimens from indwelling catheter, throat swab specimens, etc. from the distribution of departments, non repetitive Pseudomonas aeruginosa. Single cell bacteria were mainly isolated from ICU patients, accounted for 25.7% (45/175), followed by burn and plastic surgery 17.7% (31/175), 13.1% (23/175), Department of traditional Chinese medicine, Department of respiratory medicine accounted for 8.6% (15/175) and 5.1% (9/175), the rest of the pediatric specimens from other clinical unit. The analysis of drug sensitivity, non repetitive Pseudomonas aeruginosa to aztreonam, ciprofloxacin, levofloxacin, gentamicin and tobramycin resistance rates were 30%.2, collected in 293 strains of Pseudomonas aeruginosa, 117 strains of Pseudomonas aeruginosa from infection lasted for more than 30 days of patients; the 117 strains of Pseudomonas aeruginosa were amplified 19 different genotype bands were a~s type, 100%. type rate of plastic surgery in ICU and burn all occurred in the same type of RAPD detection of Pseudomonas aeruginosa strains in different patients among the remaining patients, the type of RAPD The same. 4 cases of persistent infection of Pseudomonas aeruginosa in patients from the sputum, bronchoalveolar lavage fluid, wound secretions, blood, cultivate the Pseudomonas aeruginosa RAPD fingerprint changed separation of urine specimens, the remaining 19 cases of patients with sputum, bronchoalveolar lavage fluid and isolated specimens sent in P. Pseudomonas RAPD fingerprint is not changed. Conclusion: 1, mainly occurred in the ICU of Pseudomonas aeruginosa infection, burns and plastic surgery and Department of traditional Chinese medicine; they showed different degrees of resistance to multiple antibiotics, including of aztreonam, ciprofloxacin, levofloxacin, gentamicin and tobramycin resistant rate was 30%, and the the polymyxin B resistance rate was 0, the sensitive rates of Pseudomonas aeruginosa 100%.2. gene polymorphism, partial type is highly homologous to.3. in ICU and burn plastic surgery occurred in the P. The local outbreak of Pseudomonas aeruginosa (.4.) RAPD fingerprint of Pseudomonas aeruginosa can be partially altered in the process of long-term persistent infection.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R446.5

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