本文選題：兒童 + 多重耐藥菌�。� 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:了解青島某三甲醫(yī)院住院患兒臨床分離的多重耐藥菌的分布和變化趨勢(shì)及對(duì)檢出的多重耐藥菌的耐藥性分析,指導(dǎo)臨床合理用藥。方法:回顧性分析2013-2015年于青島大學(xué)附屬醫(yī)院兒科住院患兒中分離的多重耐藥菌,對(duì)其分布、耐藥性進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:青島某三甲醫(yī)院2013-2015年共分離出469株致病菌,其中多重耐藥菌為357株,革蘭氏陽性菌208株,革蘭氏陰性菌145株,真菌4株。最多見的多重耐藥菌為多重耐藥凝固酶陰性葡萄球菌(MRCNS),其次為產(chǎn)ESBLs大腸埃希菌,耐甲氧西林金黃色葡萄球菌(MRSA);自2013-2015年耐甲氧西林金黃色葡萄球菌(MRSA)由3.09%增長至24.73%,產(chǎn)ESBLs大腸埃希菌由6.18%增長至21.50%,HLAR由1.03%增長至6.45%,產(chǎn)ESBLs肺炎雷伯菌、陰溝腸桿菌、鮑氏不動(dòng)桿菌逐年檢出率出現(xiàn)下降趨勢(shì);普通兒科檢出多重耐藥菌占總耐藥菌的40.89%,血液兒科為24.64%,新生兒科為34.47%;標(biāo)本檢出率最高為血液(56.58%),其次分別為尿液(14.29%)、痰液(8.96%),其中多重耐藥凝固酶陰性葡萄球菌(MRCNS)、耐甲氧西林金黃色葡萄球菌(MRSA)在血液中檢出最高,鮑氏不動(dòng)桿菌、產(chǎn)ESBLs肺炎克雷伯菌在痰液檢出最高。革蘭氏陽性菌對(duì)紅霉素、青霉素、克林霉素耐藥率高,而對(duì)替考拉寧、替加環(huán)素、呋喃妥因較敏感;革蘭氏陰性菌對(duì)氨芐新林、頭孢唑林、復(fù)方新諾明耐藥率高,而對(duì)厄它培南、比阿培南、頭孢噻吩較敏感。結(jié)論:自2013-2015年該三甲醫(yī)院住院兒童多重耐藥菌以革蘭氏陽性菌為主,耐甲氧西林金黃色葡萄球菌(MRSA)呈上升趨勢(shì),產(chǎn)ESBLs肺炎雷伯菌、陰溝腸桿菌、鮑氏不動(dòng)桿菌呈逐年下降趨勢(shì);檢出的多重耐藥菌主要對(duì)青霉素類、三代頭孢菌素類、大環(huán)內(nèi)酯類抗生素有較高的耐藥率,尚未培養(yǎng)出對(duì)利奈唑胺、萬古霉素耐藥或中介的多重耐藥菌,而對(duì)碳青霉烯類、加酶抑制劑復(fù)合制劑、糖肽類敏感性較高,但耐藥率出現(xiàn)升高趨勢(shì),臨床醫(yī)師需明確感染部位及時(shí)送檢細(xì)菌培養(yǎng)標(biāo)本,選擇正確、有效抗生素治療,避免多重耐藥菌產(chǎn)生及傳播。
[Abstract]:Objective: to investigate the distribution and change trend of multidrug resistant bacteria (MDR) in hospitalized children in a third class hospital in Qingdao, and to analyze the drug resistance of multidrug resistant bacteria (MDR) detected in order to guide rational drug use in clinic. Methods: the multidrug resistant bacteria isolated from pediatric hospitalized children in Qingdao University Hospital from 2013 to 2015 were retrospectively analyzed and their distribution and drug resistance were analyzed statistically. Results: a total of 469 strains of pathogenic bacteria were isolated from a third Class A Hospital in Qingdao from 2013 to 2015. Among them 357 strains of multidrug resistant bacteria 208 strains of Gram-positive bacteria 145 strains of Gram-negative bacteria and 4 strains of fungi were isolated. MRCNS was the most common multidrug resistant bacteria, followed by Escherichia coli producing ESBLs. Methicillin-resistant Staphylococcus aureus (MRSAA) increased from 3.09% to 24.73% from 2013-2015, ESBLs producing Escherichia coli increased from 6.18% to 21.50% HLAR increased from 1.03% to 6.45%, ESBLs pneumoniae and Enterobacter cloacae increased. The detection rate of Acinetobacter baumannii decreased year by year. In general pediatrics, multidrug resistant bacteria accounted for 40.89% of total drug resistant bacteria, blood paediatrics 24.64% and Cenozoic 34.47.The highest detection rate was 56.58%, followed by urine 14.29m, sputum 8.96%, multidrug resistant coagulase negative staphylococcus MRCNSSs, resistant staphylococcus. MRSAs of Staphylococcus aureus were the highest detected in blood. Acinetobacter baumannii, ESBLs-producing Klebsiella pneumoniae in sputum detected the highest. Gram-positive bacteria were highly resistant to erythromycin, penicillin and clindamycin, but sensitive to teicoplanin, tegacycline and furantoin. But it is more sensitive to ertapenem, than Apenem and cefthiophene. Conclusion: Gram-positive bacteria were the main multidrug resistant bacteria in the hospitalized children of the third Class A Hospital from 2013 to 2015. MRSAs of methicillin-resistant Staphylococcus aureus showed an increasing trend, and the production of ESBLs pneumoniae, Enterobacter cloacae and Acinetobacter baumannii decreased year by year. The multidrug resistant bacteria were mainly resistant to penicillin, cephalosporins and macrolides, and had not been cultured to linazolamine, vancomycin resistant or intermediated multidrug resistant bacteria, but to carbapenems. The sensitivity of glycopeptide was higher than that of enzyme inhibitor compound preparation, but the rate of drug resistance was increasing. The clinicians should make sure that the infection site should be detected in time, and select the correct and effective antibiotic treatment. Avoid the production and transmission of multidrug resistant bacteria.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R446.5;R72

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王康椿;譚俊青;李藹文;;某院近5年多重耐藥菌流行病學(xué)特點(diǎn)及耐藥性研究[J];國際檢驗(yàn)醫(yī)學(xué)雜志;2016年16期

2 羅萬軍;徐潤琳;陳莎;;某兒童醫(yī)院2011-2014年多重耐藥菌監(jiān)測(cè)分析[J];兒科藥學(xué)雜志;2016年01期

3 萬小華;周治球;徐淑娟;孫衛(wèi);;多重耐藥菌致患兒感染的相關(guān)危險(xiǎn)因素分析[J];抗感染藥學(xué);2015年05期

4 李梅玲;黃潔;趙昱瑾;顧秋瑩;王曉麗;譚若銘;李磊;武均;閔東;瞿洪平;;重癥監(jiān)護(hù)病房多重耐藥菌交叉感染降階梯防控策略的臨床應(yīng)用研究[J];中國感染與化療雜志;2015年06期

5 陳美戀;賈會(huì)學(xué);李六億;;多重耐藥菌感染監(jiān)測(cè)及防控現(xiàn)狀綜述[J];中國感染控制雜志;2015年08期

6 賈會(huì)學(xué);胡必杰;吳安華;徐英春;張秀月;侯鐵英;宗志勇;李衛(wèi)光;楊懷;楊蕓;劉運(yùn)喜;文建國;陸群;李六億;;多重耐藥菌感染干預(yù)效果多中心研究[J];中國感染控制雜志;2015年08期

7 李春富;孫樹梅;;兒童血液病多重耐藥菌感染的治療對(duì)策[J];中華實(shí)用兒科臨床雜志;2015年15期

8 呂春蘭;丁志紅;杭國琴;許云;郝愛軍;陳艷;;醫(yī)院多重耐藥菌的耐藥分析[J];中國感染控制雜志;2015年05期

9 姜毅;夏利平;;兒童感染性疾病的治療對(duì)策[J];中華實(shí)用兒科臨床雜志;2015年10期

10 王凌嘯;梁麗俊;;寧夏地區(qū)223例小兒泌尿系統(tǒng)感染病原菌分布及耐藥性分析[J];兒科藥學(xué)雜志;2015年03期

，

本文編號(hào)：1861650