本文選題：肺炎克雷伯菌 + 耐藥性��； 參考：《重慶醫(yī)科大學》2014年碩士論文

【摘要】：目的了解2010年到2013年我院肺炎克雷伯菌感染的流行病學及臨床特征，藥敏及產(chǎn)超廣譜β內(nèi)酰胺酶情況，為臨床抗生素的應(yīng)用提供依據(jù)。 方法采用回顧性分析方法，分析2010年1月至2013年12月間送檢到重慶醫(yī)科大學附屬第一醫(yī)院感染科實驗室的各類標本（痰液、尿液、膿液、血液、大便、膽汁、胸腹水及創(chuàng)面或傷口分泌物）中分離出肺炎克雷伯菌的病例及藥敏資料，用WHONET5.6及SPSS17.00軟件進行數(shù)據(jù)分析。 結(jié)果①流行病學及臨床特點:2010-2013年我院感染科實驗室共分離出肺炎克雷伯菌707株，其中男469例，女238例，男：女=1.96:1。患者最大年齡90歲，最小年齡15歲，平均年齡56±17歲，大于或等于60歲者占54.7%，其中60-69歲者125人，70歲者262人。707例患者中，肺炎克雷伯菌感染多發(fā)生于夏秋季，主要是6月份至11月份。②細菌分布:2010-2013年四年期間我院感染科實驗室共檢出5931株病原菌，其中腸肝菌科細菌有3711株，肺炎克雷伯菌有707株。肺炎克雷伯菌在腸桿菌科細菌的平均比例為19.1%，各年度的比例分別為20.8%、16.8%、18.7%、24.7%。臨床上分離到的肺炎克雷伯菌主要來源于痰液、血液、尿液、濃液、分泌物，分別占58.8%、10.5%、8.3%、5.5%、8.2%，其中ICU有162株，占22.9%，內(nèi)科病房321株，占45.4%，外科病房211株，占29.8%。③肺炎克雷伯菌產(chǎn)ESBLs情況:707株肺炎克雷伯菌中，產(chǎn)ESBLs菌株276株，陽性檢出率為39.0%，各年度ESBLs的檢出率分別為38.8%、36.4%、38.1%、48.9%。④藥敏結(jié)果:近4年來肺炎克雷伯菌對常見抗菌藥的耐藥率變化如下：對氨芐西林高度耐藥，，達97.3%，對哌拉西林的耐藥率為40.9%，對氨芐西林/他唑巴坦、哌拉西林/他唑巴坦、頭孢哌酮/舒巴坦的耐藥率分別為44.8%、10.2%、12.3%。對一~四代頭孢菌素的耐藥率波動在30.9-51.1%間。對亞胺培南、美羅培南、頭孢西丁的耐藥率分別為5.9%，4.1%，13.6%。對氨基糖苷類抗菌藥阿米卡星、慶大霉素的耐藥率分別為7.4%，32.1%。對喹諾酮類抗菌藥環(huán)丙沙星的耐藥率，波動在25%左右。 結(jié)論肺炎克雷伯菌的臨床分離率逐年在增加，其占腸桿菌科細菌的比例及產(chǎn)超廣譜β內(nèi)酰胺酶逐年增加，這應(yīng)引起重視，加強其耐藥性監(jiān)測，合理選擇抗生素，意義重大。
[Abstract]:Objective to investigate the epidemiology and clinical characteristics of Klebsiella pneumoniae infection from 2010 to 2013 in our hospital.Methods from January 2010 to December 2013, samples (sputum, urine, pus, blood, stool, bile) from the first affiliated Hospital infection Laboratory of Chongqing Medical University were analyzed retrospectively.Cases and drug susceptibility data of Klebsiella pneumoniae isolated from pleural and abdominal effusion and wound or wound secretions were analyzed by WHONET5.6 and SPSS17.00 software.Results 1 Epidemiological and clinical characteristics of 707 strains of Klebsiella pneumoniae were isolated from the infectious laboratory of our hospital from 2010 to 2013, of which 469 were male, 238 female, 1.96: 1 male: female.The maximum age was 90 years old, the youngest age was 15 years old, the average age was 56 鹵17 years old, the proportion of patients over 60 years old or equal to 60 years old was 54.7 years old. Among them, among the 262 patients aged from 60 to 69 years old, 262 patients aged 70 years old, Klebsiella pneumoniae infection occurred in summer and autumn, most of them were infected by Klebsiella pneumoniae in summer and autumn.From June to November, a total of 5931 strains of pathogenic bacteria were found in the infection laboratory of our hospital during the four years from June to November. There were 3711 strains of enterohepatic bacteria and 707 strains of Klebsiella pneumoniae.The average proportion of Klebsiella pneumoniae in Enterobacteriaceae is 19.1.The proportion of Klebsiella pneumoniae in each year is 20.8and 18.70.24.The clinical isolates of Klebsiella pneumoniae were mainly derived from sputum, blood, urine, concentrated fluid and secretions, accounting for 58.8% and 10.5% of them, respectively. There were 162 strains of ICU, accounting for 22.9%, 321 strains in internal medicine ward, and 211 strains in surgical ward.The ESBLs production of Klebsiella pneumoniae was 29.8.3%, among the strains of Klebsiella pneumoniae, 276 strains produced ESBLs.The positive rate of ESBLs in each year was 38.8% and 38.4% respectively. The results showed that the resistance rate of Klebsiella pneumoniae to common antimicrobial agents in the last 4 years was as follows: high resistance to ampicillin.The resistance rate of piperacillin to piperacillin was 40.9, and to ampicillin / tazobactam, piperacillin / tazobactam, cefoperazone / sulbactam was 44.8% and 10.2% respectively.The rate of resistance to cephalosporins of the first and fourth generations fluctuated in the range of 30.9-51.1%.The drug resistance rates of imipenem, meropenem and cefoxitin were 5.9% and 4.1% respectively.The resistance rates of amikacin and gentamicin to aminoglycosides were 7.4and 32.1respectively.The resistance rate of ciprofloxacin to quinolones was about 25%.Conclusion the clinical isolation rate of Klebsiella pneumoniae is increasing year by year, and the proportion of Klebsiella pneumoniae to Enterobacteriaceae and the production of extended-spectrum 尾 -lactamases are increasing year by year.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R517.6

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