本文選題：血流感染 + 播散源頭��； 參考：《華北理工大學(xué)》2017年碩士論文

【摘要】：目的通過對713例血流感染病原菌侵襲性及病原學(xué)感染特點進(jìn)行分析,尋找血流感染病原菌的侵襲途徑,查找播散源頭,切斷感染源,以減少血流感染發(fā)生率,降低患者死亡率。同時對血流感染病原菌的菌群分布,耐藥特點,耐藥表型進(jìn)行分析,指導(dǎo)臨床合理用藥,減少耐藥菌的產(chǎn)生,為臨床對血流感染的防控及治療提供依據(jù)。方法每日及時收集華北理工大學(xué)附屬醫(yī)院2015年1月到2016年12月血培養(yǎng)陽性病原菌,用Phoenix100全自動細(xì)菌鑒定/藥敏系統(tǒng)對其做出準(zhǔn)確的分離鑒定及藥敏試驗。同時及時了解患者病情,查找病原菌侵襲性特點、臨床耐藥性特點、病原菌構(gòu)成特點,并進(jìn)一步分析病原菌及科室分布,結(jié)合相關(guān)實驗室檢查和病原菌侵襲特點,查找病原菌感染源頭。同一時間段內(nèi)感染灶培養(yǎng)菌株與血培養(yǎng)檢出的菌株相同,且除外其他感染來源,認(rèn)為該感染灶為血流感染的播散源頭。結(jié)果1血流感染病原菌播散源頭情況:兩年間共檢出713株血流感染病原菌,分離率位于前五的病原菌依次為大腸埃希菌(17.8%)、肺炎克雷伯菌(16.3%)、凝固酶陰性葡萄球菌(10.9%)、鮑曼不動桿菌(7.9%)和金黃色葡萄球菌(7.7%)。靜脈導(dǎo)管來源的檢出病原菌257株(36.0%),其中226株來自中心靜脈導(dǎo)管,以凝固酶陰性葡萄球菌(72株)、鮑曼不動桿菌(55株)為主,主要分布科室為重癥醫(yī)學(xué)科和神經(jīng)外科;泌尿系感染來源146株(20.5%),以大腸埃希菌(70株)為主,主要分布科室為重癥醫(yī)學(xué)科、泌尿外科和腎內(nèi)科;腹腔感染來源114株(16.0%),以腸桿菌科細(xì)菌和鏈球菌為主,主要分布科室為重癥醫(yī)學(xué)科和普通外科;下呼吸道感染來源80株(11.2%),以肺炎鏈球菌(35株)為主,主要分布科室為呼吸內(nèi)科;外傷感染來源61株(8.6%),以金黃色葡萄球菌(39株)為主,主要分布科室為骨科。其他不明途徑55株(7.7%)。2藥物敏感情況:常見的革蘭陰性菌中,肺炎克雷伯菌和大腸埃希菌對頭孢類、喹諾酮類耐藥率較高,對碳青霉烯類、氨基糖苷類、酶抑制劑類抗生素較敏感,同時肺炎克雷伯菌的耐藥率高于大腸埃希菌,且差異有統(tǒng)計學(xué)意義(P0.01)。鮑曼不動桿菌耐藥形式嚴(yán)峻,對多種抗生素耐藥率均在較高水平。洋蔥伯克霍爾德氏菌對頭孢他啶、哌拉西林/他唑巴坦、復(fù)方新諾明、頭孢吡肟較敏感。銅綠假單胞菌對一、二代頭孢、復(fù)方新諾明天然耐藥,對頭孢他啶、哌拉西林/他唑巴坦、氨基糖苷類等抗生素敏感。常見的革蘭陽性菌中金黃葡萄球菌對青霉素耐藥率高達(dá)96.5%,腸球菌屬對青霉素、氨芐西林較敏感。四種常見陽性菌對利奈唑胺、萬古霉素、替考拉寧等均敏感。713例血流感染病原菌中檢出多重耐藥菌97例,檢出率為13.6%。其中產(chǎn)碳青霉烯酶的腸桿菌科細(xì)菌47株(48.5%),多重耐藥的鮑曼不動桿菌37株(38.1%),耐甲氧西林金黃色葡萄球菌10株(10.3%),多重耐藥的銅綠假單胞菌3株(3.1%)。檢出科室主要是重癥醫(yī)學(xué)科、神經(jīng)內(nèi)科重癥和神經(jīng)外科。無論是革蘭氏陽性球菌還是革蘭氏陰性桿菌,尿中病原菌耐藥率稍高于血中的,差異無統(tǒng)計學(xué)意義(P0.05)。痰標(biāo)本里的病原菌耐藥率明顯高于尿標(biāo)本和血液標(biāo)本的耐藥率,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論1血流感染病原菌檢出率位于前五位的依次為大腸埃希菌、肺炎克雷伯菌、凝固酶陰性葡萄球菌、鮑曼不動桿菌和金黃色葡萄球菌。2病原菌的感染途徑靜脈導(dǎo)管來源的檢出最多,檢出菌以凝固酶陰性葡萄球菌、鮑曼不動桿菌占優(yōu)勢,主要分布科室為重癥醫(yī)學(xué)科和神經(jīng)外科;泌尿系感染來源的以大腸埃希菌為主,主要分布科室為重癥醫(yī)學(xué)科、泌尿外科和腎內(nèi)科;腹腔感染來源以腸桿菌科細(xì)菌和鏈球菌為主,主要分布科室為重癥醫(yī)學(xué)科和普通外科;下呼吸道感染來源以肺炎鏈球菌為主,主要分布科室為呼吸內(nèi)科;外傷感染來源以金黃色葡萄球菌為主,主要分布科室為骨科。3無論是革蘭氏陽性菌還是革蘭氏陰性菌,尿中病原菌耐藥率稍高于血中的,差異無統(tǒng)計學(xué)意義;痰標(biāo)本里的病原菌耐藥率明顯高于尿標(biāo)本和血液標(biāo)本的耐藥率,差異有統(tǒng)計學(xué)意義。菌血癥的控制應(yīng)結(jié)合感染來源,注重查找播散源頭,積極治療感染灶,控制并減少血流感染的發(fā)生。
[Abstract]:Objective to analyze the invasiveness and pathogenic characteristics of the pathogenic bacteria in 713 cases of blood infection, search for the invasion pathway of the pathogenic bacteria of the blood flow infection, find the source of the spread of the infection, cut off the source of infection, reduce the incidence of blood flow infection and reduce the mortality of the patients. Analysis, guiding clinical rational drug use, reducing the production of drug-resistant bacteria, providing a basis for clinical prevention and treatment of blood flow infection. Methods the positive pathogenic bacteria in the blood culture of North China University of science and technology from January 2015 to December 2016 were collected in time, and the accurate identification and identification of the pathogenic bacteria were made by Phoenix100 automatic bacterial identification / drug sensitivity system. At the same time, the patient's condition, the characteristics of the pathogenic bacteria, the characteristics of the drug resistance, the characteristics of the pathogenic bacteria, the distribution of the pathogenic bacteria and the Department of the pathogens were further analyzed, and the pathogenic bacteria were found by the related laboratory examination and the characteristics of the pathogenic bacteria. The strains of the infected foci and the blood culture were detected in the same period. The strains were the same, except for other sources of infection. It was believed that the infection was the source of the spread of blood flow infection. Results the source of pathogen spread of the 1 bloodstream infection: 713 pathogens were detected in two years. The first five pathogens were Escherichia coli (17.8%), Klebsiella pneumoniae (16.3%), coagulase negative grapes. Staphylococcus (10.9%), Acinetobacter Bauman (7.9%) and Staphylococcus aureus (7.7%). 257 strains of pathogenic bacteria (36%) were detected from the source of venous catheterization. 226 of them were from central venous catheter, with coagulase negative staphylococcus (72) and Acinetobacter Bauman (55 strains), the main distribution Department was in the severe medicine department and Department of Neurosurgery; the source of urinary tract infection 146 (20.5%), mainly Escherichia coli (70 strains), the main distribution Department was the intensive medicine department, the Department of Urology and the Nephrology; the abdominal infection source was 114 (16%), mainly Enterobacteriaceae and Streptococcus, the main distribution Department was the severe medical department and the general surgery, 80 strains of lower respiratory tract infection (11.2%), and Streptococcus pneumoniae (35 strains). Main distribution Department was respiratory medicine; 61 strains of traumatic infection (8.6%), mainly Staphylococcus aureus (39 strains), the main distribution Department was Department of orthopedics. Other unknown pathways were 55 (7.7%).2 drug sensitivity: common gram-negative bacteria, Klebsiella pneumoniae and Escherichia coli resistance to cephalosporins, quinolones, high rate of quinolones, to carbon green Mycophenolate, aminoglycosides, enzyme inhibitor antibiotics are more sensitive, and the resistance rate of Klebsiella pneumoniae is higher than that of Escherichia coli, and the difference is statistically significant (P0.01). The resistant form of Acinetobacter Bauman is severe and the rate of resistance to a variety of antibiotics is at a high level. Ceftazidime, piperacillin / triazole, Burke and Holder's bacteria Bactam, compound neanolamine, cefepime are more sensitive. Pseudomonas aeruginosa is resistant to first, two generation cephalosporins, compound neoramol, and sensitive to ceftazidime, piperacillin / tazobactam, aminoglycoside. The common gram-positive bacteria are resistant to penicillin by 96.5%, Enterococcus to penicillin, ampicillin Four common positive bacteria were sensitive to linezolid, vancomycin, teicoplanin and other sensitive.713 cases, 97 cases of multidrug resistant bacteria were detected. The detection rate was 47 strains of Enterobacteriaceae (48.5%), 37 strains of Acinetobacter, and methicillin resistant gold yellow grapes, 13.6%.. 10 strains (10.3%) and 3 strains of Pseudomonas aeruginosa resistant to multi drug resistance (3.1%). The detection department is mainly in the severe medicine department, neurology severe and Department of neurosurgery. Whether it is Gram-positive or Gram-negative bacilli, the resistance rate of pathogenic bacteria in urine is slightly higher than that in blood (P0.05). The resistance of pathogenic bacteria in sputum specimens The rate of drug resistance was significantly higher than that of urine samples and blood specimens (P0.05). Conclusion the rate of detection of pathogenic bacteria in the first five places of 1 blood flow infection is in the order of Escherichia coli, Klebsiella pneumoniae, coagulase negative staphylococci, Acinetobacter Bauman and Staphylococcus aureus.2 pathogens. The most detected bacteria were coagulase negative Staphylococcus and Acinetobacter Bauman, the main distribution Department was the intensive medicine department and the Department of Neurosurgery; the main source of urinary infection was Escherichia coli, the main distribution Department was the intensive medicine department, the Department of Urology and the renal internal department; the abdominal infection source was Enterobacteriaceae and streptococcus. The main distribution Department was the intensive medicine department and general surgery. The main source of lower respiratory tract infection was Streptococcus pneumoniae and the main distribution Department was respiratory medicine. The main source of the trauma infection was Staphylococcus aureus. The main distribution Department was the Department of orthopedics.3, gram-positive or Gram-negative bacteria, and the resistance rate of pathogenic bacteria in urine was slight. The difference in resistance rate of pathogenic bacteria in sputum specimens is significantly higher than that of urine samples and blood specimens, the difference is statistically significant. The control of bacteremia should be combined with the source of infection, focus on finding the source of dissemination, actively treat the infection focus, and control and reduce the incidence of blood flow infection.

【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R446.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 崔澤林;肖迨;馮婷婷;湯榮;陳雯靜;易峻文;俞琦;洪慶;舒文;劉慶中;李莉;;血流感染糞腸球菌和屎腸球菌的臨床分布及耐藥研究[J];微生物與感染;2017年01期

2 趙玉杰;茅奇峰;李情操;裘莉佩;屠艷燁;;導(dǎo)管相關(guān)性血流感染的病原菌檢測及危險因素分析[J];中國衛(wèi)生檢驗雜志;2017年04期

3 王敏;許順姬;金春梅;石蓉;宋曉旭;;血培養(yǎng)陽性報警時間對臨床病原菌鑒別的探討[J];中華醫(yī)院感染學(xué)雜志;2017年03期

4 常軍霞;張芳;王樂;張會紅;;血培養(yǎng)常見病原菌分布特征及耐藥性分析[J];河北醫(yī)藥;2016年24期

5 沈振華;劉興暉;朱慧;姚肖嵐;;血流感染病原菌分布及其體外藥物敏感性試驗結(jié)果分析[J];檢驗醫(yī)學(xué);2016年10期

6 李小超;董愛英;蔡永冉;韓曉燕;李寧;;糞腸球菌感染性心內(nèi)膜炎1例報告[J];華北理工大學(xué)學(xué)報(醫(yī)學(xué)版);2016年05期

7 朱敏;蔡源益;曹曉紅;吳華章;;導(dǎo)管相關(guān)血流感染的疾病負(fù)擔(dān)研究進(jìn)展[J];中國醫(yī)院;2016年06期

8 鄒穎;徐曉剛;郭慶蘭;李光輝;;革蘭陰性桿菌血流感染的病原菌分布、耐藥性及碳青霉烯酶基因的檢測與分析[J];中國感染與化療雜志;2016年02期

9 翟如波;李云慧;孫躍嶺;梅旭;邱廣斌;;某院連續(xù)三年醫(yī)院血流感染病原菌分布特征及耐藥性分析[J];中華實驗和臨床感染病雜志(電子版);2016年01期

10 蔡鮮;胡志東;余倩;李妍淳;李金;徐海茹;;降鈣素原在區(qū)分不同病原體引起血流感染的價值[J];天津醫(yī)科大學(xué)學(xué)報;2016年01期

，

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