本文關(guān)鍵詞：浙江省急性腹瀉患者氣單胞菌的流行與藥物敏感性分析　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 腹瀉 氣單胞菌 流行性 藥物敏感性

【摘要】：目的:氣單胞菌(Aeromonas)廣泛存在于水環(huán)境中,是常見的人畜魚共患病原菌,已有多個(gè)國(guó)家和地區(qū)報(bào)道過其較大規(guī)模的暴發(fā)流行,成為我國(guó)水產(chǎn)養(yǎng)殖業(yè)發(fā)展的主要威脅,還能單獨(dú)或者混合感染人類,導(dǎo)致人類腸道內(nèi)外感染,是我國(guó)夏季腹瀉的常見病原菌之一,嚴(yán)重威脅公眾健康。氣單胞菌的分布情況和藥物敏感特征在世界多個(gè)地區(qū)均有報(bào)道,但本地區(qū)的相關(guān)報(bào)道比較少,本課題通過收集浙江地區(qū)急性腹瀉患者糞便標(biāo)本,開展氣單胞菌的監(jiān)測(cè)研究,以闡明氣單胞菌的流行,為臨床上科學(xué)開展腹瀉致病菌的常規(guī)檢測(cè)提供依據(jù);通過藥敏試驗(yàn),獲得浙江省氣單胞菌的耐藥譜,為氣單胞菌感染的防控提供流行病學(xué)依據(jù),為臨床氣單胞菌感染的治療提供參考,并為耐藥機(jī)制的研究奠定基礎(chǔ)。方法:2010年1月至2015年12月,從我國(guó)浙江地區(qū)6家哨點(diǎn)醫(yī)院采集急性腹瀉患者的糞便標(biāo)本,用常規(guī)微生物檢驗(yàn)程序?qū)ΤＲ娔c道致病菌進(jìn)行分離培養(yǎng),采用德國(guó)布魯克微生物鑒定質(zhì)譜儀MALDI-TOF Biotyper系統(tǒng)對(duì)微生物進(jìn)行鑒定。對(duì)分離鑒定的氣單胞菌采用紙片擴(kuò)散法(K-B法)進(jìn)行藥敏檢測(cè)及分析,并結(jié)合臨床資料對(duì)氣單胞菌進(jìn)行流行病學(xué)分析。結(jié)果:1.2010年1月-2015年12月,共收集急性腹瀉患者糞便標(biāo)本8589份,分離到503株氣單胞菌,檢出率為5.9%,列腹瀉患者細(xì)菌性病原第三位。503株氣單胞菌中豚鼠氣單胞菌最多194株(38.6%),其次是維氏氣單胞菌142株(28.2%)、嗜水氣單胞菌80株(15.9%)、腸棕氣單胞菌45株(8.9%)、簡(jiǎn)氏氣單胞菌27株(5.4%)、小魚氣單胞菌14株(2.8%)、異常嗜糖氣單胞菌1株(0.2%);2.503例氣單胞菌檢出率存在男女性別差異(P0.05),女性6.5%,男性5.3%;不同年齡組的檢出率存在統(tǒng)計(jì)學(xué)差異(P0.05),以45-59歲中年人群檢出率(7.6%)最高,其次是18-44歲青年人群(6.8%);不同季節(jié)檢出率差異具有統(tǒng)計(jì)學(xué)意義(P0.05),以夏季(6-8月)的檢出率最高,達(dá)10.2%。3.503株氣單胞菌對(duì)17種納入研究的抗菌藥中的大部分保持著較高的敏感性,對(duì)阿米卡星敏感率為94.8%,左氧氟沙星敏感率為93.8%,慶大霉素為92.4%,頭孢他啶為92.0%。但對(duì)四環(huán)素、亞胺培南和頭孢西丁的敏感率相對(duì)較低為59.0%、59.8%和61.9%,且對(duì)亞胺培南和四環(huán)素的中度敏感率較高,分別為20.7%和16.1%。4.豚鼠氣單胞菌對(duì)阿米卡星的敏感率最高,為94.8%,而對(duì)頭孢呋辛的敏感率較低,為43.0%;維氏氣單胞對(duì)氨曲南和頭孢他啶的敏感率最高,為97.9%,對(duì)亞胺培南的敏感率最低,為25.4%,而同為碳青霉烯類的美洛培南則為78.9%;嗜水氣單胞菌對(duì)阿米卡星、氨曲南敏感率最高,為97.5%,對(duì)頭孢西丁的敏感率最低,為35.0%;腸棕氣單胞菌對(duì)頭孢他啶、頭孢曲松和左氧氟沙星的敏感率達(dá)100%,最低的頭孢西丁也有60.0%;小魚氣單胞菌對(duì)頭孢他啶和左氧氟沙星的敏感率為100%,對(duì)四環(huán)素的敏感率最低,為48.1%;簡(jiǎn)氏氣單胞菌對(duì)阿米卡星、哌拉西林/他唑巴坦、慶大霉素、頭孢吡肟、頭孢噻肟和頭孢曲松的敏感率較高,為92.9%,對(duì)亞胺培南敏感率最低,為28.6%;所選的17種抗菌藥物中只有阿米卡星和哌洛西林\他唑巴坦對(duì)各菌種間的敏感性無明顯差異(P=0.669,P=0.588),且這兩種抗菌藥物對(duì)各菌種的敏感性都比較高;豚鼠氣單胞菌和腸棕氣單胞菌對(duì)亞胺培南的敏感率(82.0%,73.3%)明顯高于其他氣單胞菌(P0.05);維氏氣單胞菌、嗜水氣單胞菌、小魚氣單胞菌和簡(jiǎn)氏氣單胞菌中亞胺培南的敏感性明顯低于同為碳青霉烯類藥物的美洛培南;維氏氣單胞菌和小魚氣單胞菌對(duì)頭孢西丁的敏感率(83.1%,96.3%)明顯高于其他氣單胞菌(P0.05);豚鼠氣單胞菌和嗜水氣單胞菌對(duì)17種抗菌藥物的敏感性普遍低于維氏氣單胞菌、腸棕氣單胞菌、小魚氣單胞菌和異常嗜糖氣單胞菌(P0.05)。5.503株氣單胞菌中有128株(25.4%)氣單胞菌混合其他細(xì)菌或病毒的感染,其中以豚鼠氣單胞菌(36株,28.1%)和維氏氣單胞菌(37株,28.9%)為主,但比較容易出現(xiàn)混合感染的菌種是簡(jiǎn)氏氣單胞菌和小魚氣單胞菌,其混合感染率分別是 50.0%和 44.4%。結(jié)論:1、浙江省急性腹瀉患者中氣單胞菌檢出率高達(dá)5.9%,列腹瀉患者細(xì)菌性病原第三位,以夏季為主,感染人群以中年為多。2、腸道來源氣單胞菌主要為豚鼠氣單胞菌、維氏氣單胞菌和嗜水氣單胞菌。3、腸道氣單胞菌對(duì)阿米卡星、左氧氟沙星、慶大霉素及頭孢他啶敏感性高,對(duì)四環(huán)素、頭孢西丁和亞胺培南敏感性差,不同菌種對(duì)抗菌藥物的敏感性存在差異。
[Abstract]:Objective: Aeromonas (Aeromonas) widely exist in the water environment, is a common pathogen of human and animal fish, there are a number of countries and regions reported its popular large-scale outbreak, become a major threat to the development of aquaculture in our country, but also alone or mixed infection of humans, leading to infection of human intestinal and that is one of the common pathogenic bacteria of diarrhea in summer in our country, a serious threat to public health. The distribution and drug sensitivity characteristics of Aeromonas were reported in many parts of the world, but relatively few reports in this area, through the collection of stool specimens of patients with acute diarrhea in Zhejiang area, to carry out monitoring of Aeromonas to clarify, Aeromonas epidemic, provide the basis for clinical science to carry out routine detection of pathogenic bacteria of diarrhea; through drug sensitivity test, drug resistance in Zhejiang province Aeromonas spectrum of Aeromonas infection To provide epidemiological evidence for prevention and control, to provide reference for clinical treatment of Aeromonas infection, and study the mechanism of resistance to lay the foundation. Methods: from January 2010 to December 2015, from 6 sentinel hospitals in Zhejiang area of our country stool specimens of patients with acute diarrhea were cultured on the collection of common intestinal pathogens using conventional micro biological test program identification of microorganisms, microbial identification by Germany Brook mass spectrometer MALDI-TOF Biotyper system. The isolation and identification of Aeromonas using disk diffusion method (K-B method) for detection and analysis of drug sensitivity, and combined with the clinical data of Aeromonas were analyzed. Results: 1.2010 years in January -2015 year in December were collected, acute 8589 diarrhea stool specimens were isolated, 503 strains of Aeromonas, the detection rate was 5.9%, among patients with diarrhea bacterial pathogens of third strains of Aeromonas.503 gas in guinea pig Aeromonas 鑿屾渶澶，

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