發(fā)布時(shí)間：2017-12-26 20:20

  本文關(guān)鍵詞：駐馬店地區(qū)886例泌尿系統(tǒng)感染患者臨床特點(diǎn)及病原菌耐藥性分析　出處：《新鄉(xiāng)醫(yī)學(xué)院》2016年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 泌尿系統(tǒng)感染 臨床特點(diǎn) 病原菌 耐藥性 耐藥基因

【摘要】：背景泌尿系統(tǒng)感染(Urinary Tract Infection,UTI),是由多種病原菌直接侵入尿路而引起的尿道炎癥反應(yīng)。常見(jiàn)的感染菌包括大腸埃希桿菌和金黃色葡萄球菌等。UTI常見(jiàn)癥狀有急性單純性膀胱炎、急性單純性腎炎和復(fù)雜性尿路感染等,已經(jīng)成為最常見(jiàn)的感染性疾病之一。駐馬店地區(qū)UTI病例近年逐漸增加,然而針對(duì)該地區(qū)患者的臨床癥狀和不同病原菌的耐藥性仍然缺乏一個(gè)系統(tǒng)性認(rèn)識(shí),嚴(yán)重阻礙了有效治療方法的開(kāi)發(fā)和應(yīng)用。目的系統(tǒng)總結(jié)、探討河南省駐馬店地區(qū)UTI患者的臨床發(fā)病特點(diǎn);揭示該地區(qū)UTI患者病原菌類(lèi)型、耐藥性及其耐藥基因;為指導(dǎo)臨床治療及安全用藥、降低病原菌的耐藥率、提高患者的疾病治愈率,提供實(shí)驗(yàn)數(shù)據(jù)和科學(xué)依據(jù)。方法首先收集來(lái)自駐馬店市中心醫(yī)院、駐馬店市第一人民醫(yī)院、駐馬店市中醫(yī)院、駐馬店市第二人民醫(yī)院等四家綜合醫(yī)院連續(xù)八年(2007年1月~2014年12月)收住的UTI患者886例,統(tǒng)計(jì)患者年齡、性別、疾病臨床相關(guān)診治等基本信息,并系統(tǒng)分析患者的臨床特點(diǎn)、實(shí)驗(yàn)室檢查結(jié)果及患者病情轉(zhuǎn)歸。進(jìn)一步通過(guò)患者尿培養(yǎng)檢測(cè),探討患者病原菌分布、耐藥性及常見(jiàn)病原菌耐藥性變遷情況進(jìn)行。最后通過(guò)PCR和凝膠電泳等技術(shù)對(duì)UTI患者中產(chǎn)超廣譜β-內(nèi)酰胺酶(ESBLs)的大腸埃希菌和肺炎克雷伯菌進(jìn)行耐藥基因分析。結(jié)果1.本次研究資料中,男性患者186例(20.99%),女性患者700例(79.01%),男女患者比例為1:3.76,各年齡段患者女性均高于男性。UTI患者上行性感染843例,占95.15%,血行感染20例,占2.25%,淋巴道感染16例,占1.81%,直接感染7例,占0.79%。上尿路感染354例,占39.95%,以急、慢性腎盂腎炎為主;下尿路感染532例,占60.05%,以急性膀胱炎、前列腺炎、急性尿道炎為主�；颊咭阅蚵反碳ふ�(尿頻、尿急、尿痛)最多見(jiàn),其次為下腹痛、腰痛等,無(wú)明顯癥狀者30例。UTI患者有合并癥的460例,合并癥中最多見(jiàn)的是泌尿系結(jié)石127例(27.61%),其次是腎積水61例(13.26%)。2.886例患者中有582例檢出病原菌,陽(yáng)性率占65.69%。共檢出病原菌768株,以G-菌為主(70.05%),在G-菌中以大腸埃希桿菌(E.Coil)居首位(51.43%);G+菌(28.65%)以屎腸球菌(12.37%)和糞腸球菌(5.73%)為主。G-菌感染率一直較G+菌高,然而后四年(2011~2014)G+菌感染有增高趨勢(shì),以屎和糞腸球菌感染增多為主。3.大腸埃希菌、肺炎克雷伯菌等對(duì)多種抗菌藥物高度耐藥,但其對(duì)亞胺培南、呋喃妥因、頭孢替坦、哌拉西林/他唑巴坦和環(huán)丙沙星等高度敏感。屎腸球、糞腸球菌等對(duì)青霉素,紅霉素、環(huán)丙沙星和氨芐西林高度耐藥,但對(duì)萬(wàn)古霉素、替考拉寧和呋喃妥因高度敏感。4.25株大腸埃希菌中SHV的檢出率為40.00%(10/25),TEM的檢出率為8.00%(2/25),CTX-M檢出率為80.00%(20/25)。15株肺炎克雷伯菌中SHV的檢出率為40.00%(6/15),TEM的檢出率為26.67%(4/15),CTX-M檢出率為73.33%(11/15)。結(jié)論1.UTI感染率、并發(fā)癥在性別、年齡等方面存在差異;UTI患者病原菌仍以G-菌大腸埃希桿菌為最常見(jiàn),但近年G+菌感染率有上升趨勢(shì),以屎和糞腸球菌感染增多為主。2.在檢出的病原菌中,大腸埃希菌和肺炎克雷伯菌等對(duì)氨芐西林、復(fù)方新諾明、哌拉西林等多種抗菌藥物高度耐藥。屎腸球和糞腸球菌等對(duì)青霉素,紅霉素、環(huán)丙沙星及氨芐西林高度耐藥。3.大腸埃希菌和肺炎克雷伯菌產(chǎn)ESBLs的基因型主要為CTX-M型,第二位的是SHV型,TEM型的檢出率最低;多數(shù)菌株攜帶有2種甚至多種耐藥基因,兩種及以上的耐藥基因型共存于同一菌株中,導(dǎo)致細(xì)菌產(chǎn)生復(fù)雜多變的耐藥表型。
[Abstract]:Urinary Tract Infection (UTI) is a response to urethritis caused by the direct intrusion of a variety of pathogenic bacteria to the urinary tract. The common infected bacteria include Escherichia coli and Staphylococcus aureus. The common symptoms of UTI are acute simple cystitis, acute simple nephritis and complicated urinary tract infection, which have become one of the most common infectious diseases. UTI cases in Zhumadian area have been increasing in recent years. However, there is still a lack of systematic understanding of the clinical symptoms and drug resistance of different pathogens in this area, which seriously hampers the development and application of effective treatment methods. Objective to summarize the clinical characteristics and explore the system of UTI in Zhumadian area of Henan province; reveal the types and pathogens in patients with UTI in the area of bacteria resistance and resistance gene; drug resistance to guide clinical treatment and medication safety, reduce pathogenic bacteria rate and improve the cure rate of the disease patients, to provide experimental data and scientific basis. First, collected from Zhumadian Central Hospital, four hospitals of Zhumadian city first people's Hospital, Zhumadian city hospital, Zhumadian City Second People's Hospital for eight consecutive years (January 2007 ~2014 December) of 886 UTI patients admitted to the statistical cases, age and gender of patients, clinical diagnosis and treatment of diseases related to the basic information system, and analysis of the disease the clinical characteristics, laboratory results and prognosis of patients. Further through the detection of urine culture, the distribution of pathogenic bacteria, drug resistance and the change of common pathogenic bacteria resistance were investigated. Finally, PCR and gel electrophoresis were used to analyze the resistance genes of Escherichia coli and Klebsiella pneumoniae in UTI patients with extended spectrum beta lactamase (ESBLs). Results 1. of the data in this study, 186 cases (20.99%) were male, 700 cases (79.01%) were female, the ratio of male to female was 1:3.76, and women in all age groups were higher than men. In UTI patients, 843 cases of upper infection, 95.15%, 20 cases of blood infection, 2.25%, 16 cases of lymphatic infection, 1.81%, 7 cases of direct infection, accounting for 0.79%. 354 cases of upper urinary tract infection, accounting for 39.95%, were mainly acute and chronic pyelonephritis. 532 cases of lower urinary tract infection, accounting for 60.05%, were mainly acute cystitis, prostatitis and acute urethritis. Patients with urinary irritation symptoms (frequency, urgency, odynuria) the most common, followed by abdominal pain, back pain, 30 cases had no obvious symptoms. In UTI patients, there were 460 cases of complication. The most common complication was urinary calculi in 127 cases (27.61%), followed by 61 cases of hydronephrosis (13.26%). Among the 2.886 patients, 582 were detected the pathogenic bacteria, and the positive rate was 65.69%. A total of 768 strains of pathogens were detected, mainly G- bacteria (70.05%). Escherichia coli (E.Coil) ranked the top (51.43%) in G- bacteria, and G+ (28.65%) was mainly Enterococcus faecium (12.37%) and Enterococcus faecalis (5.73%). The infection rate of G- bacteria was higher than that of G+ bacteria, but the infection of G+ bacteria increased in the last four years (2011~2014), and increased mainly in the infection of feces and Enterococcus faecalis. 3. Escherichia coli and Klebsiella pneumoniae are highly resistant to various antibiotics, but they are highly sensitive to imipenem, furanitin, cefotidan, piperacillin / tazobactam and ciprofloxacin. E.faecium and Enterococcus faecalis to penicillin, erythromycin, ciprofloxacin and ampicillin but highly resistant to vancomycin, teicoplanin, and highly sensitive to nitrofurantoin. The detection rate of SHV in 4.25 Escherichia coli was 40% (10/25), the detection rate of TEM was 8% (2/25), and the detection rate of CTX-M was 80% (20/25). The detection rate of SHV in 15 strains of Klebsiella pneumoniae was 40% (6/15), the detection rate of TEM was 26.67% (4/15), and the detection rate of CTX-M was 73.33% (11/15). Conclusion 1.UTI infection rate and complications are different in gender and age. The most common pathogens in UTI patients are G-, Escherichia coli, but G+ infection rate is increasing in recent years. 2., among the detected pathogens, Escherichia coli and Klebsiella pneumoniae are highly resistant to ampicillin, compound sulfamethoxazole and piperacillin. Fecal balls and Enterococcus faecalis were highly resistant to penicillin, erythromycin, ciprofloxacin and ampicillin. 3. of Escherichia coli and Klebsiella pneumoniae isolated from genotype ESBLs are mainly CTX-M type, second were type SHV, type TEM, the lowest detection rate; most strains carrying various resistance and 2 genes, two or more resistant genotypes coexist in the same strain, leading to bacterial resistance the complex phenotype.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R691.3;R446.5

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