本文選題：細(xì)菌耐藥 + 革蘭陰性桿菌��； 參考：《吉林大學(xué)》2007年博士論文

【摘要】： 感染性疾病是常見的病種之一,由于抗生素的濫用,細(xì)菌的耐藥問題日趨嚴(yán)重,因此合理使用抗菌藥物,加強抗菌藥物的管理,具有長遠的社會效益,又有非常重要的經(jīng)濟效益。它是有效控制、減少、延緩病原菌產(chǎn)生耐藥的重要措施之一。由于耐藥細(xì)菌具有隨地域分布的特征,不同國家、地區(qū)、醫(yī)院的細(xì)菌耐藥類型和變遷規(guī)律不盡相同,因此,進行區(qū)域性細(xì)菌耐藥監(jiān)測勢在必行,應(yīng)該成為常規(guī)性、周期性開展的基礎(chǔ)工作。我國的細(xì)菌耐藥監(jiān)測剛剛起步,北京、上海等城市近年在這方面做了一些監(jiān)測。長春地區(qū)尚未見報導(dǎo)。所以進行本市醫(yī)院內(nèi)細(xì)菌耐藥監(jiān)測及產(chǎn)超廣譜β-內(nèi)酰胺酶基因型分布特征研究,并制定地區(qū)細(xì)菌耐藥譜,對于抗生素合理使用,控制和延緩多重耐藥菌產(chǎn)生具有重要的指導(dǎo)意義。 本文監(jiān)測2004-2006年長春市5家三級甲等醫(yī)院醫(yī)院感染患者中分離的細(xì)菌耐藥狀況。從2004年1月1日至2006年12月31日分離的3892株病原菌,其中革蘭陰性桿菌2660株,革蘭陽性球菌1232株,采用K-B紙片瓊脂擴散法進行體外敏感試驗,并按2002年美國臨床實驗標(biāo)準(zhǔn)委員會(NCCLS)指導(dǎo)原則的標(biāo)準(zhǔn)計算細(xì)菌對抗菌藥物的耐藥率(R)%、中介率(I)%和敏感率(S)%。監(jiān)測結(jié)果將以耐藥監(jiān)測卡片形式向全市發(fā)放。同時采用PCR方法擴增ESBLs基因以確定其基因型。結(jié)果發(fā)現(xiàn):1、革蘭陽性球菌:未發(fā)現(xiàn)對萬古霉素、去甲萬古霉素耐藥或中介金黃色葡萄球菌或凝固酶陰性葡萄球菌菌株。耐甲氧西林凝固酶陰性葡萄球比例有逐年升高趨勢。屎腸球菌對胺芐西林耐藥率為72.4%,明顯高于糞腸球菌對胺芐西林的耐藥率37.5%。2、革蘭陰性桿菌:占前四位的是大腸埃希菌(43%)、克雷伯菌屬(16%)、銅綠假單胞菌(12%)、不動桿菌(10%)。碳青霉烯類是對革蘭陰性桿菌(除外嗜麥芽窄食單胞菌)抗菌作用最強的一類抗生素。頭孢哌酮/舒巴坦、哌拉西林/他唑巴坦、頭孢吡肟和新氟喹諾酮類,如加替沙星、左氧氟沙星對革蘭陰性桿菌亦有很好的抗菌活性,但仍有50%-60%的大腸埃希菌對氟喹諾酮類耐藥。3、大腸埃希菌和肺炎克雷伯菌產(chǎn)ESBLs檢出率為41.2%,ESBLs基因型以CTX-M為主,且耐藥率明顯高于非產(chǎn)ESBLs大腸埃希菌和肺炎克雷伯菌。 本文首次進行長春市醫(yī)院內(nèi)細(xì)菌耐藥監(jiān)測,按NCCLS指導(dǎo)原則的標(biāo)準(zhǔn)計算細(xì)菌對抗菌藥物的耐藥率(R)%、中介率(I)%和敏感率(S)%,并預(yù)期將監(jiān)測結(jié)果以耐藥監(jiān)測卡片形式向全市發(fā)放。使臨床醫(yī)師了解本地區(qū)醫(yī)院內(nèi)感染性疾病病原學(xué)藥敏情況、病原變遷情況及常見耐藥ESBLs基因亞型分子流行病特征,做到合理的經(jīng)驗性使用抗生素,這將對本地區(qū)的抗生素合理使用,控制和延緩多重耐藥菌產(chǎn)生具有重要的指導(dǎo)意義。
[Abstract]:Infectious disease is one of the common diseases. Because of the abuse of antibiotics, the problem of bacterial drug resistance is becoming more and more serious, so rational use of antimicrobial agents and strengthening the management of antimicrobial agents have long-term social benefits. There are also very important economic benefits. It is one of the important measures to control, reduce and delay the drug resistance of pathogenic bacteria. Because drug resistant bacteria have the characteristics of geographical distribution, the types and changes of drug resistance in different countries, regions and hospitals are different. Therefore, it is imperative to monitor the drug resistance of regional bacteria, which should be routine. Basic work carried out periodically. Surveillance of bacterial resistance has just started in China, and Beijing, Shanghai and other cities have done some monitoring in this area in recent years. Changchun has not been reported yet. Therefore, the surveillance of bacterial drug resistance and the distribution characteristics of extended-spectrum 尾 -lactamases genotypes were carried out in the hospitals of this city, and the bacterial drug resistance profiles were established for the rational use of antibiotics. It is of great significance to control and delay the production of multidrug resistant bacteria. The drug resistance of bacteria isolated from 5 patients with Grade 3A nosocomial infection in Changchun from 2004 to 2006 was monitored. 3892 strains of pathogenic bacteria were isolated from January 1, 2004 to December 31, 2006, of which 2660 were Gram-negative bacilli and 1232 Gram-positive cocci. In vitro sensitivity tests were carried out by K-B disk Agar diffusion method. According to the standard of NCCLS2002, the resistance rate of bacteria to antimicrobial agents was calculated, and the mediating rate and sensitivity rate were calculated. The monitoring results will be issued to the whole city in the form of drug resistance monitoring cards. At the same time, ESBLs gene was amplified by PCR to determine its genotype. The results showed that: 1, Gram-positive cocci: no vancomycin, norvancomycin resistant or intermediate Staphylococcus aureus or coagulase-negative staphylococcus strains were found. The proportion of methicillin-resistant coagulase negative grape balls increased year by year. The resistance rate of Enterococcus faecium to ampicillin was 72.4, which was significantly higher than that of Enterococcus faecalis to ampicillin. Carbapenem is the most potent antibiotic against Gram-negative bacilli (excluding Stenotrophomonas maltophilia). Cefoperazone / sulbactam, piperacillin / tazobactam, cefepime and new fluoroquinolones, such as gatifloxacin, levofloxacin, also have good antibacterial activity against gram-negative bacilli. However, 50% to 60% of Escherichia coli were resistant to fluoroquinolones. The positive rate of ESBLs production of Escherichia coli and Klebsiella pneumoniae was 41.2%. The resistance rate of Escherichia coli and Klebsiella pneumoniae was significantly higher than that of non-producing Escherichia coli and Klebsiella pneumoniae. In this paper, the bacterial drug resistance monitoring in Changchun hospital was carried out for the first time. According to the standard of NCCLS guidelines, the drug resistance rate of bacteria to antimicrobial agents was calculated. The mediating rate and sensitivity rate were calculated, and the results were expected to be issued to the whole city in the form of drug resistance monitoring cards. To make clinicians understand the pathogenic drug sensitivity, pathogen changes and molecular epidemiological characteristics of common drug resistant ESBLs gene subtypes in local hospitals, so as to make rational empirical use of antibiotics. This will be of great significance to the rational use of antibiotics, control and delay the production of multidrug resistant bacteria.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2007
【分類號】：R446.5;R378

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