發(fā)布時間：2018-06-08 17:23

  本文選題：金黃色葡萄球菌肺炎 + 耐藥性�。� 參考：《重慶醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：分析金黃色葡萄球菌肺炎(staphylococcus aureuspneumonia，SAP)的臨床特點(diǎn)及金黃色葡萄球菌(staphylococcus aureus，SA)的耐藥性，為臨床診斷和合理用藥提供依據(jù)。 方法：回顧性分析44例重慶醫(yī)科大學(xué)兒童醫(yī)院2008年9月~2013年12月確診為金黃色葡萄球菌肺炎的臨床特點(diǎn)及其藥敏結(jié)果。 結(jié)果：（1）SAP患兒男女比為2.67:1，以3歲以下嬰幼兒和6歲以上學(xué)齡期兒童居多。SAP比一般細(xì)菌性肺炎病情重、進(jìn)展快、病情變化快，其典型癥狀包括長時間持續(xù)或反復(fù)高熱、嚴(yán)重感染中毒癥狀重及感染性休克。30（68.2%）例SAP患兒實(shí)驗(yàn)室檢查有白細(xì)胞升高，，36例（81.8%）患兒中性比例升高。42例進(jìn)行C反應(yīng)蛋白檢查，其中33例（78.6%）增高。21例患兒進(jìn)行了降鈣素原檢查，均增高。39例（88.6%）患兒出現(xiàn)并發(fā)癥，SAP易致多器官感染和多臟器功能損害。（2）44株SA對氨芐青霉素（100%vs96.2%）、阿莫西林/棒酸（42.5%vs3.8%）、慶大霉素（19.0%vs3.8%）、環(huán)丙沙星（9.3%vs0%）、利福平（7.3%vs0%）的耐藥率明顯高于我院1993-2003年SA的耐藥率。44株SA中甲氧西林敏感金黃色葡萄球菌菌株（methicillin-sensitiveStaphy1ococcus aureus，MSSA）29例（65.9%），甲氧西林耐藥金黃色葡萄球菌菌株（methicillin-resistant Staphy1ococcus aureus，MRSA）15例（34.1%）。SA對青霉素、氨芐青霉素、紅霉素、克林霉素、頭孢西丁、阿莫西林/棒酸、苯唑西林的耐藥率分別為100%、100%、74.4%、73.8%、58.6%、42.5%、39.0%，對四環(huán)素、甲氧芐氮嘧啶、復(fù)方新諾明、妥布霉素、慶大霉素、莫匹羅星、阿米卡星、環(huán)丙沙星、利福平、莫匹羅星-HL、呋喃妥因耐藥率較低，分別為29.3%、28.6%、26.2%、23.8%、19.0%、18.2%、9.5%、9.3%、7.3%、4.7%、2.4%，尚未發(fā)現(xiàn)對萬古霉素、替考拉林、利奈唑胺、奎魯普丁/達(dá)福普丁、夫西地酸耐藥的SA菌株。MRSA對苯唑西林、頭孢西丁、紅霉素、克林霉素、利福平、阿莫西林/棒酸的耐藥率顯著高于MSSA，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論：重慶地區(qū)SAP好發(fā)于3歲以下嬰幼兒和6歲以上學(xué)齡期兒童，SAP比一般細(xì)菌性肺炎病情重、進(jìn)展快、變化快，容易出現(xiàn)多器官組織并發(fā)癥，加強(qiáng)金黃色葡萄球菌的耐藥監(jiān)測對指導(dǎo)臨床用藥有重要意義。重慶地區(qū)SA對多種抗生素的耐藥率呈增加趨勢，SA對β-內(nèi)酰胺類抗生素耐藥率高，MRSA對多種抗生素的耐藥性顯著高于MSSA。
[Abstract]:Objective: to analyze the clinical characteristics of Staphylococcus aureus pneumoniae (SAP) and the drug resistance of Staphylococcus aureus SAP. Methods: 44 cases of Staphylococcus aureus pneumonia diagnosed in Children's Hospital of Chongqing Medical University from September 2008 to December 2013 were analyzed retrospectively. The ratio of male to female was 2.67: 1. The majority of children under 3 years old and 6 years old were children of school age. SAP was more serious than general bacterial pneumonia. Rapid progression, rapid changes in the condition, its typical symptoms include prolonged or repeated high fever, Severe infection and severe septic shock (68.2%). Laboratory examination of 36 cases with elevated leukocyte count in 36 cases with elevated leukocyte in 36 cases (81.8%). Among them 33 cases (78.6%) were examined for C-reactive protein, and 21 cases were examined for procalcitonin (P < 0.05). All of the 39 children with complications of SAP were prone to multiple organ infection and multiple organ function damage. The resistant rate of SA to ampicillin 100 vs 96. 2 was significantly higher than that of rifampicin on ampicillin 100 vs 96. 2, amoxicillin / piperonium 42.5 vs 3. 8, gentamicin 19.0 vs 3. 8, ciprofloxacin 9.3vs0 and rifampicin 7.3vs0. The drug resistance rate of methicillin-sensitive Staphylococcus aureus strains from 1993 to 2003 was 44 strains of SA. 29 cases of methicillin-sensitive Staphy1ococcus aureus and 15 cases of methicillin-resistant Staphy1ococcus aureus MRSAA were treated with penicillin, and 15 cases with methicillin-resistant Staphy1ococcus aureus MRSAA were treated with methicillin-resistant Staphy1ococcus aureus MRSA.Methicillin-resistant Staphylococcus aureus MRSA15 cases were treated with methicillin-sensitive Staphy1ococcus aureus. The drug resistance rates of ampicillin, erythromycin, clindamycin, cefoxitin, amoxicillin / rhodoxicillin, oxacillin and oxacillin were 100 / 100 and 74.4 / 74.4respectively, and 73.8 / 58.6and 42.5cm, respectively, to tetracycline, trimethoprim, compound sulfamethoxine, tobramycin, gentamycin, mopiroxacin, ampicillin, trimethoprim, tobramycin, gentamycin, mopiroxine, and ampicillin. The drug resistance rates of amikacin, ciprofloxacin, rifampicin, mupiroxin--HL, furantoin were lower, 29.30.28.6c26.2 and 19.823.823.818.2cm, respectively, and 9.59.3c7.3cm = 4.72.4.The resistance to vancomycin, tecorarin, linazolamine, quinapudine / daputin was not found. Oxacillin, cefoxitin, erythromycin, clindamycin, rifampicin, rifampicin, The drug resistance rate of amoxicillin / knotonic acid was significantly higher than that of MSSA.The difference was statistically significant (P 0.05). Conclusion: SAP in Chongqing area is more severe, faster and faster than that of general bacterial pneumonia in infants under 3 years old and children aged 6 years in school. Multiple organ and tissue complications are easy to occur. It is important to strengthen the drug resistance monitoring of Staphylococcus aureus. The resistance rate of SA to multiple antibiotics in Chongqing area showed an increasing trend. The resistance rate of SA to 尾 -lactam antibiotics was higher than that of MRSA to multiple antibiotics.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R725.6

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