本文選題：病原菌 + 耐藥性�。� 參考：《延邊大學(xué)》2017年碩士論文

【摘要】：目的:了解2013年-2015年3年間延邊醫(yī)院患者病原菌的分布及對(duì)抗菌藥物的耐藥情況,為將來控制細(xì)菌耐藥的進(jìn)一步加重和制定更合理的抗菌方案提供依據(jù)。方法:由我院化驗(yàn)室收集2013-2015年醫(yī)院臨床各科室送檢的各類標(biāo)本進(jìn)行分離培養(yǎng)�；A(chǔ)數(shù)據(jù)采用EXCEL整理。統(tǒng)計(jì)分析,使用SPSS17.0進(jìn)行趨勢(shì)卡方檢驗(yàn),P0.05有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.共檢出病原菌5693株,其中革蘭陰性菌(gram-negative bacteria G-)4258株,占 74.79%、革蘭陽性菌(gram-positive bacteria G+)1399 株,占 24.05%、真菌 66株,占1.16%;三年中一直居于前六位的病原菌為鮑曼不動(dòng)桿菌(acinetobacter baumannii,Aba)(633 株,11.12%)、大腸埃希菌(E.coli,Eco)(1216 株,21.36%)、銅綠假單胞菌(pseudomonas aeruginsa,Pae)(460 株,8.08%)、陰溝腸桿菌(Enterobacter cloaca,Ecl)(304 株,5.34%)、肺炎克雷伯菌(klebsiella pneumonia,Kpn)(761 株,13.37%)、金黃色葡萄球菌(staphylococcus aureus,Sau)(583 株,10.24%)。3年檢出耐甲氧西林金黃色葡萄球菌(Methicillin-resistant Staphylococcus aureu,MRS A)222 株,檢出產(chǎn)超廣譜 β—內(nèi)酸胺酶(Extended-spectrum β-lactamasesi,ESBL)的陰溝腸桿菌1株。檢出產(chǎn)ESBL的大腸埃希菌314株,產(chǎn)ESBL-kpn 50株。其中Eco、Aba逐年增加,Ecl呈下降趨勢(shì),有統(tǒng)計(jì)學(xué)意義,P0.05。3年耐藥性分析顯示,Aba對(duì)多粘菌素耐藥率最低(0.95%-16.15%),其次為慶大霉素和頭孢他啶,耐藥率分別為21.74%,29.81%,其他的頭孢類及碳青霉烯類耐藥性均較高,都在40%以上。Sau對(duì)阿莫西林/克拉維酸鉀,哌拉西林/他唑巴坦耐藥率分別為13.96-19.02%,6.3-11.21%,2014年檢出1株對(duì)利奈唑胺耐藥的Sau,2015年發(fā)現(xiàn)1株對(duì)替考拉寧耐藥的菌株。Ecl對(duì)阿莫西林/克拉維酸鉀,氨芐西林存在較高的耐藥性88.949%-94.12%,58.89%-70.59%,對(duì)阿米卡星,頭孢類耐藥率較低,經(jīng)過趨勢(shì)卡方檢驗(yàn),耐藥性呈降低趨勢(shì)。Kpn對(duì)頭孢吡肟、頭孢噻肟、哌拉西林/他唑巴坦耐藥率分別為11.11-15.12%、16.67-20.31%、6.3-11.21%,且卡方檢驗(yàn)呈下降趨勢(shì)。Pae對(duì)阿米卡星、慶大霉素的耐藥性為6.88-0.8%、12.5-2.4%,耐藥率逐年下降,并且具有統(tǒng)計(jì)學(xué)意義。Eco對(duì)碳青霉烯類的敏感性2015年為100%,對(duì)頭孢吡肟、哌拉西林、左氧氟沙星的耐藥性為 11.52-29.28%、70.28-73.68%、55.64-59.87%,經(jīng)統(tǒng)計(jì)分析,耐藥率有增高趨勢(shì)。結(jié)論:1.我院2013-2015年病原菌分布以革蘭陰性菌為主,變化趨勢(shì)跟相關(guān)報(bào)道相符。耐甲氧西林金黃色葡萄球菌、廣譜β-內(nèi)酰胺酶菌株及耐碳青霉烯類肺炎克雷伯菌檢出率較低。2.對(duì)我院臨床常用的喹諾酮類—左氧氟沙星的耐藥率升高的是Aba、Ecl;耐藥率下降的是Pae、Kpn;對(duì)Eco的耐藥情況無明顯變化。3.對(duì)頭孢吡肟耐藥率升高的病原菌為Eco、Kpn、Aba;頭孢西丁對(duì)Ecl的耐藥率升高。4.Sau、Aba、Kpn、Pae對(duì)亞胺培南的耐藥率均高于對(duì)美羅培南的耐藥率。
[Abstract]:Objective: to investigate the distribution of pathogenic bacteria and drug resistance of patients in Yanbian Hospital from 2013 to 2015 so as to provide a basis for controlling the further aggravation of drug resistance of bacteria and making more rational antimicrobial schemes in the future. Methods: samples collected from clinical departments of our hospital from 2013 to 2015 were isolated and cultured. The basic data is sorted out by EXCEL. Statistical analysis, using SPSS17.0 for trend chi-square test (P0.05) has statistical significance. The result is 1: 1. A total of 5693 strains of pathogenic bacteria were detected, of which 4258 were gram-negative bacteria G-G (74.79), 1399 were gram-positive bacteria G (24.05%), 66 strains were fungi. 1. 16; the top six pathogens for three years were Acinetobacter baumanniiani 633, Escherichia coli E. coliformis, E. coli Ecosiella 1216, Pseudomonas aeruginsaa Pae460, M. aeromonas aeruginsaa Pae460, Enterobacter cloacae Ecllc 304 strain 5.34T, Klebsiella pneumoniae klebsiella pneumoniae, klebsiella pneumoniae, 13.3737 golden yellow, C. aeromonas pseudomonas aeruginsaa Pae460 strain 8.08A, Enterobacter cloacae Ecllentella strain 5.34T, Klebsiella pneumoniae klebsiella pneumoniae 761. A total of 583 strains of Staphylococcus aureus were found to be methicillin-resistant Staphylococcus aureus, and 222 strains of methicillin-resistant Staphylococcus aureus were detected in this year. A strain of Enterobacter cloacae producing Extended-spectrum 尾 -lactamase ESBL was tested. Strains of Escherichia coli producing ESBL and 50 strains of ESBL-kpn were tested. The drug resistance of EcoA to polymyxin was the lowest (0.95-16.15), followed by gentamicin and ceftazidime. The resistance rates of other cephalosporins and carbapenes were higher, and the resistance rates were above 40%. Sau was resistant to amoxicillin / clavulanate potassium. The drug resistance rates of piperacillin / tazobactam were 13.96-19.026.3-11.21 in 2014, and one resistant strain was found to be resistant to alnazolidomide. In 2015, a strain resistant to teicoplanin was found to be resistant to amoxicillin / clavulanate, and ampicillin had a higher resistance to amoxicillin, 88.949-94.121,58.89-70.59m, and to amikacin, it was found that there was a high resistance to amikacin. The resistance rates of cefepime, cefotaxime and piperacillin / tazobactam were 11.11-15.1216.67-20.31 and 6.3-11.21, respectively, and the chi-square test showed a decreasing trend. Pae showed a decreasing trend to amikacin, and the resistance rate of cefepime to cefepime, cefotaxime and piperacillin / tazobactam were 11.11-15.127.20.31 and 6.3-11.21, respectively. The drug resistance of gentamicin was 6.88-0.8cm 12.5-2.4.The resistance rate decreased year by year, and the sensitivity of Eco to carbapenem was 100 in 2015, and to cefepime, piperacillin and levofloxacin was 11.52-29.2870.28-73.6855.64-59.87.The drug resistance was 11.52-29.2870.28-73.6855.64-59.87. The rate of drug resistance is increasing. Conclusion 1. Gram-negative bacteria were the main pathogens in our hospital from 2013 to 2015, and the change trend was consistent with the related reports. The detection rate of methicillin-resistant Staphylococcus aureus, broad-spectrum 尾 -lactamases and carbapene-resistant Klebsiella pneumoniae was lower. The resistant rate of Quinolone-Levofloxacin was higher than that of Paeto Kpn, and the resistance to Eco had no significant change. 3. The resistant rate of cefepime to Ecl was higher than that of cefepime, and the resistant rate of cefoxitin to Ecl was higher than that to imipenem. 4. The resistant rate of cefepime to imipenem was higher than that to meropenem.
【學(xué)位授予單位】：延邊大學(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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