本文關(guān)鍵詞：急診內(nèi)科下呼吸道感染細(xì)菌分布及耐藥性分析　出處：《皖南醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 細(xì)菌分布 耐藥性 抗生素選擇

【摘要】：目的:了解轄區(qū)或醫(yī)療機(jī)構(gòu)內(nèi)抗菌藥物臨床應(yīng)用和細(xì)菌耐藥情況,定期對(duì)抗菌藥物臨床應(yīng)用管理和細(xì)菌耐藥形式進(jìn)行評(píng)價(jià),根據(jù)監(jiān)測(cè)情況,逐步建立完善的抗菌藥物臨床應(yīng)用機(jī)制可以使抗生素的應(yīng)用更加規(guī)范及合理化。所以動(dòng)態(tài)監(jiān)測(cè)我院急診內(nèi)科細(xì)菌急重癥下呼吸道感染患者細(xì)菌分布及耐藥性的變遷,為初始經(jīng)驗(yàn)性廣譜抗生素的選擇提供依據(jù),同時(shí)分析細(xì)菌及其耐藥性變遷的原因,為其多重耐藥菌感染的預(yù)防提供依據(jù)。方法:收集我院急診內(nèi)科2014.1—2016.12收治的下呼吸道感染病例,對(duì)臨床分離病原菌的細(xì)菌分布及耐藥性進(jìn)行回顧性分析;結(jié)果:共收集下呼吸道感染病例805例,年齡為38歲至95歲之間,60歲以上老年患者占91.62%,共檢出細(xì)菌及真菌258例,陽(yáng)性率32.05%。分離出細(xì)菌共151例,最常見(jiàn)的細(xì)菌為銅綠假單胞菌共39例,鮑曼不動(dòng)桿菌共28例,肺炎克雷伯菌29例,其他細(xì)菌為副流感嗜血桿菌、肺炎鏈球菌、金黃色葡萄球菌等,共54例;近年來(lái),銅綠假單胞菌所占比例有下降趨勢(shì),鮑曼不動(dòng)桿菌所占比例有明顯上升趨勢(shì),且多耐藥菌比例加重,幾乎所有檢出的鮑曼不動(dòng)桿菌均為多耐藥菌。3年間肺炎克雷伯菌的檢出率無(wú)明顯差異。銅綠假單胞菌對(duì)β-內(nèi)酰胺酶抑制劑及氨基糖苷類抗生素敏感性高,故建議聯(lián)合應(yīng)用,不僅可以縮短療程,還可以減少藥物副作用的發(fā)生;銅綠假單胞菌對(duì)碳青霉烯類抗生素的耐藥性有上升趨勢(shì),且頻繁使用碳青霉烯類抗生素會(huì)誘導(dǎo)多耐藥菌株的出現(xiàn),故建議在治療上應(yīng)慎用,同時(shí)加強(qiáng)多耐藥銅綠假單胞菌菌株的檢出,及時(shí)作出預(yù)防措施。結(jié)論:我科細(xì)菌耐藥性呈逐年上升的趨勢(shì),多重耐藥菌廣泛出現(xiàn),應(yīng)根據(jù)細(xì)菌分布及對(duì)藥物的敏感性合理選擇抗生素,對(duì)預(yù)防耐藥菌的出現(xiàn)具有重要意義。
[Abstract]:Objective: to understand the area or within the medical institutions for clinical application of antibacterials and bacterial resistance to antimicrobial drugs, regular management of clinical application and bacterial resistance forms were evaluated according to the monitoring, and gradually establish and improve the mechanism of clinical application of antibacterial drugs can help the application of antibiotics more standardized and rational. So the change of dynamic monitoring of the emergency internal medicine in our hospital of acute bacterial severe lower respiratory tract infection in patients with bacterial distribution and drug resistance, to provide the basis for the choice of initial empiric broad-spectrum antibiotics, and analysis the reasons for changes in bacteria and drug resistance, provide the basis for the prevention of the multi drug resistant bacteria infection. Methods: collected in our hospital emergency internal medicine 2014.1 - 2016.12 from lower respiratory tract infection, bacterial distribution and drug resistance of clinical isolates the pathogens were retrospectively analyzed; results: collected 805 cases of lower respiratory tract infection, age Between 38 and 95 years old, 60 years old accounted for 91.62% of patients were found in bacteria and fungi in 258 cases, the positive rate of 32.05%. bacteria isolated from a total of 151 cases, the most common bacteria were Pseudomonas aeruginosa in 39 cases, a total of 28 cases of Bauman Acinetobacter, Klebsiella pneumoniae in 29 cases, other bacterial vice Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, a total of 54 cases; in recent years, the proportion of Pseudomonas aeruginosa decreased, Bauman Acinetobacter proportion has increased significantly, and the proportion of multi drug resistant bacteria increased, almost all were Bauman Acinetobacter were during the period of.3 resistant strains of Klebsiella pneumoniae were detected. No significant differences in the rates of Pseudomonas aeruginosa to beta lactamase inhibitors and aminoglycoside antibiotic sensitivity, the combination can not only shorten the course of treatment, can also reduce the adverse reactions; Pseudomonas aeruginosa Bacterial resistance to carbapenems are rising, and the frequent use of carbapenem antibiotics induced by multi drug resistant strains, it is recommended in the treatment should be used with caution, while strengthening the detection of multi drug resistant Pseudomonas aeruginosa strains, timely preventive measures. Conclusion: our department of bacterial resistance increased year by year the trend of multidrug-resistant bacteria is widespread, a reasonable choice of antibiotics should be based on the distribution of bacteria and the drug sensitivity, it is very important for prevention of drug-resistant bacteria.

【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R56;R446.5

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