本文選題：特發(fā)性肺間質(zhì)纖維化　切入點(diǎn)：急性加重　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討特發(fā)性肺間質(zhì)纖維化(IPF)住院患者痰培養(yǎng)病原菌分布及耐藥情況,為經(jīng)驗(yàn)性抗感染治療提供依據(jù)。方法:通過我院病案室國(guó)際疾病編碼查詢系統(tǒng),使用疾病編碼J84.001(肺泡蛋白沉積癥)、J84.101(肺纖維化)、J84.104(特發(fā)性肺間質(zhì)纖維化)、J84.105(間質(zhì)性纖維性肺泡炎)、J84.106(彌漫性肺間質(zhì)纖維化)、J84.108(機(jī)化性肺炎)、J84.109(炎癥后纖維化)、J84.800(特指間質(zhì)性肺病)、J84.803(肺彌漫性間質(zhì)病變)、J84.900(間質(zhì)性肺病)查詢我院2014年10月-2016年10月符合上述檢索條件的住院患者,篩選出臨床資料完整、符合IPF診斷標(biāo)準(zhǔn)、并因呼吸困難急性惡化住院者,分析其痰培養(yǎng)病原菌分布及耐藥性,應(yīng)用SPSS21.0進(jìn)行統(tǒng)計(jì)學(xué)處理。結(jié)果:按上述檢索條件,共檢索出病例639例,其中符合IPF診斷標(biāo)準(zhǔn)、因呼吸困難急性惡化住院者共102例,共送檢369次痰培養(yǎng)檢查,分離出68株原菌,陽(yáng)性率為18.43%。其中革蘭陰性桿菌46株(67.65%),前四位的分別為鮑曼不動(dòng)桿菌、肺炎克雷伯桿菌、銅綠假單胞菌、大腸埃希菌,革蘭陽(yáng)性菌5株(5.88%),金黃色葡萄球菌居首位。真菌16株(23.53%),主要為白假絲酵母菌。鮑曼不動(dòng)桿菌對(duì)替加環(huán)素、頭孢哌酮鈉舒巴坦鈉、阿米卡星的耐藥率分別為0、13.33%、26.67%,對(duì)其他細(xì)菌的耐藥率均大于60%。肺炎克雷伯桿菌對(duì)頭孢哌酮鈉舒巴坦鈉、頭孢替坦、頭孢曲松、呋喃妥因、頭孢吡肟、慶大霉素、亞胺培南、復(fù)方新諾明、頭孢他啶、妥布霉素、阿米卡星、美羅培南、哌拉西林他唑巴坦耐藥率均低于30%。銅綠假單胞菌對(duì)頭孢哌酮鈉舒巴坦鈉、阿米卡星、美羅培南、頭孢他定、亞胺培南、妥布霉素、環(huán)丙沙星、頭孢吡肟、慶大霉素、鹽酸左氧氟沙星均低于40%,對(duì)哌拉西林他唑巴坦、哌拉西林、氨曲南的耐藥率為40%,而對(duì)氨芐西林、頭孢曲松、頭孢替坦、呋喃妥因的耐藥率均為90%。大腸埃希菌對(duì)亞胺培南、阿米卡星、美羅培南的耐藥率均為11.11%,對(duì)頭孢哌酮鈉舒巴坦鈉、妥布霉素、哌拉西林他唑巴坦的耐藥率均為22.22%,對(duì)環(huán)丙沙星、頭孢替坦、慶大霉素的耐藥率均為33.33%,對(duì)頭孢他定的耐藥率均為44.44%,對(duì)左氧氟沙星、頭孢吡肟、氨曲南、頭孢曲松的耐藥率為55.56%,對(duì)呋喃妥因、頭孢呋辛、復(fù)方新諾明、氨芐西林及哌拉西林的耐藥率均大于70%。分離的革蘭氏陽(yáng)性細(xì)菌對(duì)萬(wàn)古霉素、替加環(huán)素、喹努普汀/達(dá)福普汀、利奈唑胺敏感率均為100%。分離的病原菌均對(duì)氟康唑、伊曲康唑、伏立康唑敏感。結(jié)論:IPF住院患者痰培養(yǎng)病原菌主要為革蘭陰性桿菌,其次是真菌,革蘭陽(yáng)性球菌所占的比例較少。革蘭陰性桿菌中,鮑曼不動(dòng)桿菌的檢出率高、耐藥性強(qiáng)、耐菌譜廣,對(duì)碳青酶烯類藥物耐藥率較高,而對(duì)替加環(huán)素、頭孢哌酮鈉舒巴坦鈉、阿米卡星耐藥率較低,可作為治療選擇,而其他革蘭陰性桿菌對(duì)碳青霉烯類、β-內(nèi)酰胺類抗生素/酶抑制劑復(fù)合制劑、氨基糖苷類抗生素仍保持較高的敏感性。在革蘭陽(yáng)性球菌感染的病原菌中,未發(fā)現(xiàn)對(duì)替加環(huán)素、利奈唑胺、萬(wàn)古霉素耐藥的菌株,治療中可選用上述藥物。同時(shí)應(yīng)該警惕真菌感染,白色假絲酵母菌仍然是IPF合并真菌感染最常見的致病菌。
[Abstract]:Objective: To investigate the idiopathic pulmonary fibrosis (IPF) culture of pathogen distribution and drug resistance in patients with sputum, to provide the basis for empirical anti infective therapy. Methods: the Department of medical records international disease encoding query system, using J84.001 encoding disease (Pap), J84.101 (pulmonary fibrosis), J84.104 (idiopathic pulmonary fibrosis (J84.105), interstitial fibrosing alveolitis (J84.106), diffuse pulmonary interstitial fibrosis (J84.108), organizing pneumonia (J84.109), inflammatory fibrosis (especially J84.800), interstitial lung disease (J84.803), diffuse pulmonary interstitial lesions), J84.900 (ILD) query in our hospital in October 2014 -2016 year in October in accordance with the search condition in hospitalized patients, screening out the complete clinical data, meet the criteria for the diagnosis of IPF, and because of dyspnea acute exacerbation of the hospitalized, analyze the sputum culture distribution and drug resistance of pathogenic bacteria, the application of SPSS21.0 Data were analyzed statistically. Results: according to the retrieval conditions, a total of 639 cases, which were consistent with the diagnostic criteria of IPF, acute deterioration due to breathing difficulties hospitalized a total of 102 cases, 369 were from sputum culture examination, 68 strains of pathogenic bacteria, the positive rate of 18.43%. among 46 strains of gram negative bacilli (67.65%) four, respectively Bauman Acinetobacter, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, 5 strains of gram positive bacteria (5.88%), Staphylococcus aureus ranked first (23.53%). 16 strains of fungi, mainly Candida albicans. Bauman Acinetobacter of tegafur minocycline and cefoperazone sodium and sulbactam sodium, Amikacin drug resistance rates were 0,13.33%, 26.67%, resistant to other bacteria were more than 60%. of Klebsiella pneumoniae of cefoperazone sodium and sulbactam sodium, cefotetan, ceftriaxone, nitrofurantoin, gentamicin, cephalosporin cefepime, imipenem, compound Sulfamethoxazole, ceftazidime, tobramycin, Amikacin, meropenem, piperacillin tazobactam resistance rates were lower than the 30%. of Pseudomonas aeruginosa to cefoperazone sulbactam, Amikacin, ceftazidime, meropenem, imipenem, tobramycin, ciprofloxacin, cefepime, gentamicin, levofloxacin hydrochloride were lower than 40% that of piperacillin tazobactam, piperacillin, aztreonam ammonia resistant rate was 40%, and ceftazidime to ampicillin, ceftriaxone, cefotetan, nitrofurantion were Amikacin 90%. of Escherichia coli to imipenem, meropenem amine, drug resistance rate was 11.11%, tobramycin of cefoperazone sodium sulbactam, and piperacillin tazobactam resistance rate was 22.22%, cefotetan, ciprofloxacin, gentamicin resistance rate was 33.33%, he set on cephalosporin resistance rate were 44.44%, of levofloxacin, ceftazidime Cefepime, aztreonam, ceftriaxone resistant rate was 55.56%, of nitrofurantoin, cefuroxime, cotrimoxazole, gram positive bacteria resistant ampicillin and piperacillin were greater than 70%. separation of vancomycin, tigecycline, quinupristin / Dafoe and leptin, linezolid sensitive rate as the pathogen 100%. isolated were sensitive to fluconazole, itraconazole, Fushita Yasu. Conclusion: IPF in patients with sputum culture the main pathogens were gram negative bacilli, followed by fungi, gram positive cocci accounted for less. Gram negative bacilli in Bauman Acinetobacter high detection rate, strong resistance, resistance a broad spectrum of bacteria, high carbopenems resistant rate of tigecycline, cefoperazone sodium and sulbactam sodium, Amikacin low resistance rate, can be used as a treatment option, while other gram negative bacilli to carbapenems, beta lactam antibiotics / enzyme Inhibitor, aminoglycoside antibiotics still maintain high sensitivity. In gram positive cocci infection of pathogenic bacteria, not found on tigecycline and linezolid, vancomycin resistant strains, the selection of drugs in the treatment. At the same time should be wary of fungal infection, Candida albicans is still the most pathogenic bacteria the common IPF complicated with fungal infection.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 宋寧;袁勝芳;賈偉華;;2016年感染性疾病學(xué)重要臨床進(jìn)展[J];臨床薈萃;2017年02期

2 胡付品;F.-P.Hu;Y.Guo;D.-M.Zhu;F.Wang;X.-F.Jiang;Y.-C.Xu;X.-J.Zhang;C.-X.Zhang;P.Ji;Y.Xie;M.Kang;C.-Q.Wang;A.-M.Wang;Y.-H.Xu;J.-L.Shen;Z.-Y.Sun;Z.-J.Chen;Y.-X.Ni;J.-Y.Sun;Y.-Z.Chu;S.-F.Tian;Z.-D.Hu;J.-Li;Y.-S.Yu;J.Lin;B.Shan;Y.Du;Y.Han;S.Guo;L.-H.Wei;L.Wu;H.Zhang;J.Kong;Y.-J.Hu;X.-M.Ai;C.Zhuo;D.-H.Su;Q.Yang;B.Jia;W.Huang;;2005-2014年CHINET中國(guó)細(xì)菌耐藥性監(jiān)測(cè)網(wǎng)5種重要臨床分離菌的耐藥性變遷[J];中國(guó)感染與化療雜志;2017年01期

3 胡付品;朱德妹;汪復(fù);蔣曉飛;徐英春;張小江;張朝霞;季萍;謝軼;康梅;王傳清;王愛敏;徐元宏;沈繼錄;孫自鏞;陳中舉;倪語(yǔ)星;孫景勇;褚云卓;田素飛;胡志東;李金;俞云松;林潔;單斌;杜艷;郭素芳;魏蓮花;吳玲;張泓;王春;胡云建;艾效曼;卓超;蘇丹虹;汪瑞忠;房華;俞碧霞;趙勇;龔萍;;2015年CHINET細(xì)菌耐藥性監(jiān)測(cè)[J];中國(guó)感染與化療雜志;2016年06期

4 張輝;張小江;徐英春;胡志東;李金;孫自鏞;簡(jiǎn)翠;汪復(fù);朱德妹;卓超;蘇丹虹;褚云卓;俞云松;林潔;徐元宏;沈繼錄;倪語(yǔ)星;孫景勇;張朝霞;季萍;魏蓮花;吳玲;王傳清;薛建昌;張泓;王春;胡云建;艾效曼;單斌;杜艷;楊青;謝軼;康梅;韓艷秋;郭素芳;黃文祥;賈蓓;;2005—2014年CHINET不動(dòng)桿菌屬細(xì)菌耐藥性監(jiān)測(cè)[J];中國(guó)感染與化療雜志;2016年04期

5 郭憲立;袁勝芳;宋寧;;基于Delphi技術(shù)的特發(fā)性肺間質(zhì)纖維化急性加重定義、診斷、治療的專家共識(shí)簡(jiǎn)介[J];臨床薈萃;2016年06期

6 沈繼錄;潘亞萍;徐元宏;倪語(yǔ)星;孫景勇;王傳清;王愛敏;徐英春;張小江;汪復(fù);朱德妹;胡付品;蔣曉飛;單斌;杜艷;張泓;孔菁;卓超;蘇丹虹;楊青;魏蓮花;吳玲;張朝霞;季萍;胡志東;李金;胡云建;艾效曼;謝軼;康梅;俞云松;林潔;孫自鏞;陳中舉;黃文祥;賈蓓;褚云卓;田素飛;韓艷秋;郭素芳;;2005—2014年CHINET大腸埃希菌耐藥性監(jiān)測(cè)[J];中國(guó)感染與化療雜志;2016年02期

7 張yN博;孫景勇;倪語(yǔ)星;俞云松;林潔;楊青;徐英春;張小江;孫自鏞;陳中舉;汪復(fù);朱德妹;胡付品;蔣曉飛;王傳清;王愛敏;卓超;蘇丹虹;胡云建;艾效曼;黃文祥;賈蓓;張朝霞;季萍;張泓;孔菁;魏蓮花;吳玲;徐元宏;沈繼錄;單斌;杜艷;胡志東;李金;謝軼;康梅;韓艷秋;郭素芳;褚云卓;田素飛;;2005—2014年CHINET銅綠假單胞菌耐藥性監(jiān)測(cè)[J];中國(guó)感染與化療雜志;2016年02期

8 宋寧;段林;賀文舒;;特發(fā)性肺間質(zhì)纖維化的全球發(fā)病率和病死率[J];臨床薈萃;2015年07期

9 王鑫;曹孟淑;蔡后榮;;特發(fā)性肺纖維化急性加重及感染的診治[J];中國(guó)呼吸與危重監(jiān)護(hù)雜志;2015年02期

10 劉芳;趙建;丁日高;;特發(fā)性肺纖維化防治研究進(jìn)展[J];人民軍醫(yī);2014年04期

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