【摘要】：目的通過收集安徽省細菌耐藥監(jiān)測中心2013-2015年臨床分離銅綠假單胞菌菌株,對其感染分布及耐藥性情況進行分析,了解其耐藥變遷情況。同時篩選出泛耐藥銅綠假單胞菌,評價聯(lián)合用藥組的體外抑菌作用,尋求有效的聯(lián)合抗菌藥物。材料與來源菌株來源收集安徽省細菌耐藥監(jiān)測中心所屬40家醫(yī)院2013至2015年臨床分離的銅綠假單胞菌(已去除來自同一患者相同部位的重復菌株)共829株。質控菌為銅綠假單胞菌ATCC27853,為安徽省細菌耐藥監(jiān)測中心保存菌株。方法1.收集2013-2015年安徽地區(qū)臨床分離銅綠假單胞菌,按照2015CLSI標準,用瓊脂倍比稀釋法測定所收集菌株的MIC值,并運用WHONET 5.6軟件分析細菌感染分布及耐藥性等。2.篩選出PDRPA,運用棋盤法聯(lián)合藥敏試驗進行體外抑菌實驗,為臨床藥物的選擇提供參考。結果1.安徽省細菌耐藥監(jiān)測中心2013年至2015年共收集臨床分離銅綠假單胞菌829株,2013年-2015年分別為309株、232株、288株,占臨床總分離革蘭陰性菌比例為12.0%、14.4%、12.1%2.標本主要來自于痰液、膿液及分泌物、尿液、血液等多個部位。3.銅綠假單胞菌對阿米卡星、哌拉西林/他唑巴坦、頭孢吡肟以及頭孢他啶仍較為敏感且三年內耐藥率較為穩(wěn)定;對頭孢唑肟等三代頭孢耐藥率顯著升高;對環(huán)丙沙星耐藥率有所下降;對于亞胺培南及美羅培南的耐藥率基本持平。4.多粘菌素E+利福平、多粘菌素E+亞胺培南、多粘菌素E+頭孢他啶、哌拉西林/他唑巴坦+阿米卡星、頭孢他啶+環(huán)丙沙星五組抗菌藥物對于泛耐藥銅綠假單胞菌主要起到協(xié)同相加作用。結論1.銅綠假單胞菌感染仍占臨床感染一定比例,泛耐藥銅綠假單胞菌的不斷檢出表明抗生素耐藥形勢的嚴峻,為臨床治療增加了難度;2.多粘菌素等多種抗感染藥物聯(lián)合使用可作為對泛耐藥銅綠假單胞菌感染的治療方案。
[Abstract]:Objective to analyze the distribution of infection and drug resistance of Pseudomonas aeruginosa strains isolated from 2013 to 2015 in Anhui Provincial Monitoring Center for bacterial Resistance and to find out the changes of drug resistance of Pseudomonas aeruginosa strains. The pan-resistant Pseudomonas aeruginosa was screened to evaluate the bacteriostatic effect of the combined drug group in vitro and to seek effective combined antimicrobial agents. Materials and source strains 829 strains of Pseudomonas aeruginosa were collected from 40 hospitals of Anhui Province from 2013 to 2015. The quality control strain was Pseudomonas aeruginosa ATCC27853, which was preserved by Anhui Provincial Monitoring Center for bacterial Resistance. Method 1. The clinical isolates of Pseudomonas aeruginosa from 2013 to 2015 in Anhui province were collected. According to the 2015CLSI standard, the MIC values of the collected strains were determined by Agar doubling dilution method, and the distribution of bacterial infection and drug resistance were analyzed by WHONET 5.6 software. PDRPA, was selected to use chessboard method combined with drug sensitivity test for in vitro bacteriostasis test to provide a reference for the selection of clinical drugs. Result 1. From 2013 to 2015, 829 clinical isolates of Pseudomonas aeruginosa were collected in Anhui Provincial Monitoring Center for bacterial Resistance, and 309 strains of Pseudomonas aeruginosa were collected from 2013 to 2015, accounting for 288 strains of Pseudomonas aeruginosa, accounting for 12.0% of the total isolated Gram-negative bacteria. The specimens are mainly from sputum, pus and secretions, urine, blood and other parts. 3. Pseudomonas aeruginosa was still sensitive to amikacin, piperacillin / tazobactam, cefepime and ceftazidime, and the resistance rate to cefazoxime was stable in three years. The resistance rate of ciprofloxacin to ciprofloxacin decreased, and to imipenem and meropenem was almost equal. 4. Polymyxin E rifampicin, polymyxin E imipenem, polymyxin E ceftazidime, piperacillin / tazobactam amikacin, Ceftazidime ciprofloxacin five groups of antimicrobial agents for pan-resistant Pseudomonas aeruginosa play a synergistic role. Conclusion 1. Pseudomonas aeruginosa infection still accounted for a certain proportion of clinical infections. The continuous detection of pan-resistant Pseudomonas aeruginosa showed that the antibiotic resistance situation was severe, which increased the difficulty of clinical treatment. The combined use of polymyxin and other anti-infective drugs can be used as a treatment for pan-resistant Pseudomonas aeruginosa infection.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R446.5

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