本文選題：細(xì)菌耐藥　切入點(diǎn)：鮑曼不動(dòng)桿菌　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:統(tǒng)計(jì)分析我院2012年至2015年臨床分離的細(xì)菌分布及G-菌耐藥變遷情況,以了解目前細(xì)菌耐藥情況,指導(dǎo)臨床合理選擇抗生素。方法:對(duì)我院所有臨床分離菌采用統(tǒng)一方案進(jìn)行細(xì)菌藥敏試驗(yàn),分別按各年CLSI標(biāo)準(zhǔn)判斷結(jié)果。結(jié)果:1.細(xì)菌分布情況我院4年共收集臨床分離菌31632株,各年分別占19.2%(6067/31632)、22.9%(7237/31632)、29.8%(9435/31632)、28.1%(8893/31632),其中革蘭陽(yáng)性菌33.2%(10512/31632)株,革蘭陰性菌66.8%(21120/31632)。革蘭陰性菌中,大腸桿菌占首位,各年分別占25.8%(1017/3941)、24.7%(1186/4803)、26.2%(1663/6355)、29.8%(1792/6021),其次為肺炎克雷伯桿菌,銅綠假單胞菌位于第三。其中鮑曼不動(dòng)桿菌位于第六。2.細(xì)菌的標(biāo)本分布本研究中,臨床分離的菌株主要來源于患者痰液、尿液、血液、分泌液、膿液及其他,分別占52.9%(16736/31632)、8.1%(2566/31632)、3.5%(1109/31632)、11.7%(3691/31632)、7.7%(2426/31632)、16.1%(5104/31632)。其中,痰標(biāo)本占第一位,其中以肺炎克雷伯桿菌為最常見的細(xì)菌,其次是金黃色葡萄球菌;分泌物中常見的細(xì)菌為表皮葡萄球菌及大腸埃希菌;尿液中近一半是大腸埃希菌,其次是腸球菌;血液及膿液中主要為大腸埃希菌。3.G-對(duì)常見抗生素的耐藥性變遷腸桿菌科細(xì)菌,對(duì)碳青霉烯類、含酶抑制劑的合成抗生素、氨基糖苷類抗生素均保持較高的敏感性,大腸埃希菌對(duì)四代頭孢的耐藥率比三代頭孢高,但對(duì)四代頭孢的敏感性有逐年回升的趨勢(shì),對(duì)氟喹諾酮類的耐藥率分別為42.5%、44.4%、42.9%、40.3%;肺炎克雷伯桿菌對(duì)氟喹諾酮類的耐藥率較低,對(duì)三代、四代頭孢耐藥率無明顯變化趨勢(shì);變形桿菌對(duì)三代頭孢的耐藥率各年分別為11.6%、9.1%、8.9%、13.8%;對(duì)四代頭孢、氟喹諾酮類的耐藥率均較高;腸桿菌屬對(duì)三代、四代頭孢、氟喹諾酮類的耐藥率均有逐年下降的趨勢(shì)。在不發(fā)酵糖革蘭陰性菌中,銅綠假單胞菌對(duì)碳青霉烯類、含酶抑制劑的合成抗菌藥物、氨基糖苷類的敏感性相對(duì)較高,對(duì)三代頭孢(頭孢他啶)的耐藥率各年分別為17.9%、10.1%、12.0%、12.4%;對(duì)四代頭孢(頭孢吡肟)的耐藥率分別為19.8%、11.3%、10.7%、11.8%;鮑曼不動(dòng)桿菌對(duì)亞胺培南耐藥率分別為65.5%、36.4%、59.3%、75.0%,對(duì)美羅培南的耐藥率分別為83.9%、88.7%、90.4%;對(duì)含酶抑制劑合成抗菌素、三代頭孢、四代頭孢、氨基糖苷類、氟喹諾酮類的耐藥率均較高,除對(duì)氨基糖苷類的耐藥率有逐年下降的趨勢(shì)外,都呈逐年上升的趨勢(shì)(P0.05)。結(jié)論:我院主要細(xì)菌的分布與CHINET顯示的結(jié)果基本一致,但鮑曼不動(dòng)桿菌所占比例較國(guó)內(nèi)其他醫(yī)院低。我院細(xì)菌總的耐藥情況日漸嚴(yán)重,尤其是鮑曼不動(dòng)桿菌,對(duì)各種抗菌藥物的敏感性均差,且耐藥率有逐年上升的趨勢(shì)。部分耐藥率高于同期國(guó)內(nèi)水平,故需警惕細(xì)菌耐藥加重。
[Abstract]:Objective: to analyze the distribution of clinical bacteria isolated from 2012 to 2015 in our hospital and the changes of drug resistance of G- bacteria in order to find out the current situation of bacterial drug resistance. Methods: the antibiotic susceptibility test was carried out on all clinical isolates in our hospital according to the CLSI standard of each year. Results: 1. 31632 strains of clinical isolates were collected in our hospital for 4 years. Each year accounted for 19.267 / 31632 / 22.99.90 / 7237 / 31632 / 29.8and 943535 / 31632 / 28.1and 8893 / 31632 / 8893 / 31632, respectively, among which the gram positive bacteria 33.210512 / 31632, gram negative bacteria 66.8112031632, gram-negative bacteria 66.8112031632.The gram-negative bacteria occupied the first place among the gram-negative bacteria, and each year accounted for 25.8% 10173941% 24.771 886 803% 26.26363 16355P 29.817926021, followed by Klebsiella pneumoniae. Pseudomonas aeruginosa is in third place. Acinetobacter baumannii is located in 6th. 2. The sample distribution of bacteria in this study was mainly from patients' sputum, urine, blood, secretions, pus and others, accounting for 52.9% 16736 / 31632 / 3.51066 / 31632 / 3.51096 / 31632 / 11.3691 / 31632 / 7 / 7 / 7. Klebsiella pneumoniae was the most common bacteria, followed by Staphylococcus aureus; Staphylococcus epidermidis and Escherichia coli were common bacteria in secretions; and Escherichia coli was found in nearly half of the urine. Escherichia coli in blood and pus. 3. 3. G- resistance to common antibiotics Enterobacteriaceae, carbapenems, synthetic antibiotics containing enzyme inhibitors, The resistance rate of Escherichia coli to the fourth generation of cephalosporins was higher than that of the third generation of cephalosporins, but the sensitivity to the fourth generation of cephalosporins increased year by year. The drug resistance rates of Klebsiella pneumoniae to fluoroquinolones were 42.5% and 44.44.49%, respectively, while the resistance rates of Klebsiella pneumoniae to fluoroquinolones were lower than those of the third and fourth generations. The resistance rates of Proteus to the third generation of cephalosporins were 11.69.1and 8.80.The resistance rates to the fourth generation of cephalosporins and fluoroquinolones were higher, and Enterobacter spp. To the third generation and the fourth generation of cephalosporins, The susceptibility of Pseudomonas aeruginosa to carbapenems, synthetic antimicrobial agents containing enzyme inhibitors and aminoglycosides was relatively high. The drug resistance rates of the third generation of ceftazidime were 17.9 / 10.1 and 12.40, respectively; the resistance rates to the fourth generation of cefepime were 19.8and 11.310.7 / 11.8, respectively; the resistance rates of Acinetobacter baumannii to imipenem were 65.56.46.46.47.45 and 75.0, respectively, and those to meropenem were 75.56.46.4and 59.3mm, respectively. The drug resistance rates of acinetobacter baumannii to imipenem were 75.0, and those to meropenem were 75.0, respectively. 83.9% 88.7 and 90.4%; synthesis of antibiotics against enzyme inhibitors, The resistance rates of the third generation, the fourth generation, the aminoglycosides and fluoroquinolones were all high, except the resistance rate of aminoglycosides decreased year by year. Conclusion: the distribution of main bacteria in our hospital is consistent with the results of CHINET, but the proportion of Acinetobacter baumannii is lower than that in other hospitals in China. Especially Acinetobacter baumannii, the sensitivity to various antimicrobial agents is poor, and the drug resistance rate is rising year by year. Part of the drug resistance rate is higher than the domestic level in the same period, so it is necessary to guard against the aggravation of bacterial drug resistance.
【學(xué)位授予單位】：重慶醫(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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