發(fā)布時間：2018-01-15 01:37

  本文關(guān)鍵詞：寧醫(yī)大總院急診膿毒癥病原學(xué)分析　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 膿毒癥 病原學(xué) 耐藥性 急診 大腸埃希菌

【摘要】：目的:通過對寧醫(yī)大總院急診科2014年~2015年收治的膿毒癥患者病原學(xué)結(jié)果進(jìn)行回顧性分析研究,為膿毒癥患者的抗菌藥物應(yīng)用提供依據(jù),提高膿毒癥患者經(jīng)驗性抗菌藥物治療的有效性。方法:采集寧醫(yī)大總院急診科2014年1月1日~2015年12月31日收治的膿毒癥患者的血液、痰液、胸腔積液、腹水、腦脊液等標(biāo)本,采用法國梅里埃公司生產(chǎn)的VITEK-2compact細(xì)菌自動鑒定系統(tǒng)進(jìn)行細(xì)菌鑒定,應(yīng)用紙片擴(kuò)散法(Kirby-Bauer)進(jìn)行體外藥敏試驗,參照2014~2015年美國臨床實驗室標(biāo)準(zhǔn)化委員會(CLSI)推薦的指南判斷結(jié)果,統(tǒng)計軟件采用SPSS 17.0。結(jié)果:151例患者共獲得207株分離菌,其中革蘭陰性菌占59.4%(123/207),革蘭陽性菌29.0%(60/207),真菌11.6%(24/207)。前五位分離菌依次為大腸埃希菌、肺炎克雷伯菌、鮑曼不動桿菌、金黃色葡萄球菌和屎腸球菌,分別占24.6%、12.6%、9.7%、9.7%、9.2%。大腸埃希菌以院外獲得感染菌為主,主要來源于血培養(yǎng),對亞胺培南100%敏感,院外獲得感染大腸埃希菌對除氨芐西林舒巴坦、哌拉西林他唑巴坦、呋喃妥因和亞胺培南外的抗菌素耐藥率均較院內(nèi)獲得感染菌高。肺炎克雷伯菌對氨芐西林100%耐藥,對哌拉西林、呋喃妥因、氟喹諾酮類抗菌素和第二代頭孢菌素外的抗菌藥物100%敏感。未檢出耐碳青霉烯類腸桿菌科細(xì)菌(CRE)。鮑曼不動桿菌及銅綠假單胞菌以院內(nèi)獲得感染菌為主,主要來源于痰標(biāo)本,鮑曼不動桿菌對大部分抗菌藥物耐藥率均在80%以上,其中亞胺培南耐藥率已達(dá)95%,廣泛耐藥鮑曼不動桿菌(XDRAB)檢出率達(dá)90%,對多數(shù)抗菌藥物耐藥率仍呈上升趨勢。金黃色葡萄球菌對呋喃妥因、利奈唑烷、奎奴普汀、替加環(huán)素、替考拉寧和萬古霉素100%敏感,對青霉素100%耐藥,對多數(shù)抗菌藥物耐藥率呈增長趨勢。耐甲氧西林金黃色葡萄球菌(MRSA)檢出率為45.0%。屎腸球菌對苯唑西林、復(fù)方新諾明、替考拉寧、替加環(huán)素和萬古霉素100%敏感,未檢出耐萬古霉素腸球菌(VRE)。24株真菌中以念珠菌為主,占91.7%(22/24),念珠菌對氟胞嘧啶100%敏感,其次為兩性霉素和伏立康唑,耐藥率為7.1%。結(jié)論:我院急診膿毒癥患者分離菌以革蘭陰性菌為主,多來源于血標(biāo)本,肺部感染最多,首位分離菌為大腸埃希菌,未檢出CRE,鮑曼不動桿菌和銅綠假單胞菌以院內(nèi)獲得感染菌為主,耐藥形勢嚴(yán)峻,未檢出耐萬古霉素革蘭陽性球菌,臨床需密切監(jiān)測細(xì)菌耐藥性并采取多方面措施以減緩耐藥性的增長。
[Abstract]:Objective: the pathogen of sepsis patients on Ningxia Medical University general hospital emergency department admitted in 2014 ~2015 findings were retrospectively analyzed, and provide the basis for the application of antibacterial drugs in patients with sepsis, improve the effectiveness of empirical antibiotic therapy in patients with sepsis. Methods: Jining Medical University general hospital emergency department in January 1, 2014 ~2015 year in December 31st from the blood of patients with sepsis, sputum, pleural effusion and ascites, cerebrospinal fluid samples, the bacteria were identified by VITEK-2compact bacteria identification system of France bioMerieux company, using paper disc diffusion method (Kirby-Bauer) in vitro susceptibility test, according to 2014~2015 National Committee for clinical laboratory standards (CLSI) guidelines for judging results the use of statistical software SPSS 17.0. results: 151 patients received a total of 207 strains of bacteria, including gram negative bacteria accounted for 59.4%, gram positive (123/207) Bacteria 29%, fungi (60/207) 11.6% (24/207). The top five pathogens were Escherichia coli, Klebsiella pneumoniae, Acinetobacter Bauman, Staphylococcus aureus and Enterococcus faecium, respectively 24.6%, 12.6%, 9.7%, 9.7%, 9.2%. of Escherichia coli in out of hospital acquired infection bacteria mainly, mainly from the blood culture, 100% sensitive to imipenem, hospital acquired infection of Escherichia coli in addition to ampicillin sulbactam, piperacillin tazobactam, antibiotic resistance of nitrofurantoin and imipenem were the rate of nosocomial infection bacteria. Drug resistance of pneumonia Cray Borrelia bacteria to ampicillin was 100%. To piperacillin, nitrofurantoin, fluoroquinolone antibiotics and second generation cephalosporin antibiotics outside the 100% sensitive. No detection of carbapenem resistant Enterobacteriaceae (CRE). Bauman bacillus and Pseudomonas aeruginosa in nosocomial infection bacteria do not move, mainly from sputum From Bauman Acinetobacter to most antimicrobial resistance rates were above 80%, the imipenem resistance rate has reached 95%, extensive drug resistant Acinetobacter Bauman (XDRAB) the detection rate was 90%, the majority of antibacterial drug resistance rate is still increasing. Staphylococcus aureus to nitrofurantoin, linezolid. Que Manu F Dean, tigecycline, teicoplanin and vancomycin 100% sensitive, 100% resistant to penicillin, for most antibiotics is increasing. Methicillin resistant Staphylococcus aureus (MRSA) detection rate of 45.0%. Enterococcus faecium to oxacillin, cotrimoxazole, teicoplanin, tigecycline and vancomycin. 100% sensitive, no detection of vancomycin resistant enterococci (VRE).24 fungi Candida, Candida albicans accounted for 91.7% (22/24), sensitive to flucytosine and amphotericin 100%, followed by voriconazole, the resistant rate was 7.1%. conclusion: the emergency department of our hospital Patients with sepsis isolates of Gram-negative bacteria, mostly from blood samples, pulmonary infection, first isolated bacteria were Escherichia coli, CRE was not detected, Bauman coli and Pseudomonas aeruginosa in nosocomial infection bacteria resistance does not move, the situation is grim, not detected resistant to vancomycin gram positive cocci, clinical need to closely monitor the bacterial resistance and take various measures to slow the growth of drug resistance.

【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R459.7

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