本文選題：耐甲氧西林金黃色葡萄球菌 + 院內(nèi)感染　； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:調(diào)查我院MRSA感染的分布情況,評(píng)估萬(wàn)古霉素、替考拉寧與利奈唑胺治療MRSA感染的療效與安全性。方法:搜集重慶醫(yī)科大學(xué)附屬第一醫(yī)院2013年1月-2016年6月期間上報(bào)至院感科的MRSA培養(yǎng)陽(yáng)性病例,統(tǒng)計(jì)其標(biāo)本類型及來(lái)源科室,分析我院院內(nèi)MRSA感染的分布情況。根據(jù)用藥的不同將其分為3組,即萬(wàn)古霉素組、替考拉寧組與利奈唑胺組,記錄患者治療前后癥狀、體征、細(xì)菌清除情況及不良反應(yīng)并進(jìn)行統(tǒng)計(jì)分析,比較三者的療效及副作用。結(jié)果:1)我院3年間從送檢標(biāo)本中共分離出111株MRSA菌株,標(biāo)本中以痰居多,占72.07%,其次分別為血液(占9.91%),分泌物(占8.11%),穿刺液(占4.50%),膿(占2.70%),靜脈導(dǎo)管(占1.80%),尿(占1.00%)。患者男女比例為:1.7:1,50歲以上者占60.67%。各科室中,以神經(jīng)外科(包含ICU)、神經(jīng)內(nèi)科(包含ICU)、外科ICU、呼吸科(包含ICU)及中心ICU為最多。2)共89例病例納入比較,其中包括萬(wàn)古霉素組43例,替考拉寧組27例,利奈唑胺組19例,三種藥物有效率分別為:萬(wàn)古霉素65.12%,替考拉寧66.67%,利奈唑胺68.40%,細(xì)菌清除率為萬(wàn)古霉素30.0%,替考拉寧33.3%,利奈唑胺31.6%,三組間比較差異均沒(méi)有統(tǒng)計(jì)學(xué)意義(P0.05)。不良反應(yīng)發(fā)生率比較:萬(wàn)古霉素32.6%,替考拉寧18.5%,利奈唑胺21.0%,三組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。平均治療時(shí)間為:萬(wàn)古霉素組(13.72±9.19)d,替考拉寧組(13.85±10.45)d,利奈唑胺組(13.65±8.32)d,三組間兩兩比較差異均沒(méi)有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:需對(duì)重點(diǎn)科室加強(qiáng)監(jiān)督管理,嚴(yán)格無(wú)菌操作,避免交叉感染,合理用藥,降低感染風(fēng)險(xiǎn)。萬(wàn)古霉素、替考拉寧與利奈唑胺控制MRSA感染療效相當(dāng),臨床選用時(shí)可根據(jù)患者具體情況決定。
[Abstract]:Objective: To investigate the distribution of MRSA infection in our hospital and evaluate the efficacy and safety of vancomycin, teicoplanin and linezolid in the treatment of MRSA infection. Methods: collect the positive cases of MRSA culture in the hospital of First Affiliated Hospital of Chongqing Medical University during the period of June -2016 January 2013, and to analyze the type of specimen and the Department of origin, and analyze me. The distribution of MRSA infection in hospital was divided into 3 groups according to the different drugs, namely vancomycin group, teicoplanin group and linezolid group. The symptoms, signs, bacterial clearance and adverse reactions were recorded before and after treatment, and the effects and side effects of the three were compared. Results: 1) our hospital was divided from the samples in 3 years. 111 strains of MRSA strains were isolated, 72.07% were sputum, followed by blood (9.91%), secretions (8.11%), puncture fluid (4.50%), pus (2.70%), venous catheter (1.80%), and urine (1%). The proportion of men and women over the age of 1.7:1,50 was in the various departments of 60.67%., with Department of Neurosurgery (including ICU), and Neurology (including ICU). Section ICU, Department of respiration (including ICU) and central ICU were the maximum of.2) in a total of 89 cases, including vancomycin group 43 cases, teicoplanin group 27 cases, linezolid group 19 cases, three kinds of drugs effective respectively: vancomycin 65.12%, teicoplanin 66.67%, linezolid 68.40%, bacterial clearance rate of vancomycin 30%, teicoalin 33.3%, Li teicoplanin 33.3%, There was no statistically significant difference between the 31.6% and three groups of nazolamine (P0.05). The incidence of adverse reactions was compared: vancomycin 32.6%, teicoplanin 18.5%, linezolid 21%, and three groups had no statistically significant difference (P0.05). The average time of treatment was: vancomycin group (13.72 + 9.19) d, teicoplanin group (13.85 + 10.45) d, linezolid group 13. (13.) 65 + 8.32) d, the difference between the three groups was not statistically significant (P0.05). Conclusion: it is necessary to strengthen the supervision and management of the key departments, strictly aseptic operation, avoid cross infection, rational use of drugs and reduce the risk of infection. The curative effect of vancomycin, teicoplanin and linezolid in controlling MRSA infection can be determined according to the specific situation of the patients. Make sure.
【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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