本文選題：下呼吸道 + 病原菌分布　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:對(duì)下呼吸道感染病原體的研究隨著調(diào)查區(qū)域和范圍的不同會(huì)有很大的區(qū)別,所以本次研究以我院下呼吸道感染病人痰液標(biāo)本作為研究對(duì)象,進(jìn)行細(xì)菌培養(yǎng)及藥敏試驗(yàn),對(duì)大量實(shí)驗(yàn)結(jié)果進(jìn)行分析總結(jié),最后得出我院下呼吸道感染患者致病微生物的最新分布數(shù)據(jù)及耐藥特點(diǎn),并對(duì)資料進(jìn)行進(jìn)一步的挖掘,用最新的分布數(shù)據(jù)及耐藥特點(diǎn)與我院公布的上一年的感染調(diào)查報(bào)告作比較分析,得出致病菌分布及耐藥特性的變遷。以給予臨床參考,促進(jìn)抗生素的合理運(yùn)用。方法:收集我院2016年1月1日至2016年12月31日我院病人的下呼吸道感染患者中痰液標(biāo)本,培養(yǎng)后如果在同一份痰液標(biāo)本中,生長(zhǎng)超過(guò)三種及以上的細(xì)菌,則認(rèn)定為痰液污染,如果有兩種細(xì)菌,則選取優(yōu)勢(shì)菌進(jìn)行鑒定和藥敏分析。用法國(guó)生物梅里埃細(xì)菌鑒定儀和DADE BEHRING全自動(dòng)微生物鑒定儀進(jìn)行細(xì)菌鑒定和藥敏試驗(yàn)。所有菌株鑒定到種,必要時(shí)采用傳統(tǒng)生化方法和K—B法進(jìn)行補(bǔ)充鑒定。藥敏試驗(yàn)驗(yàn)結(jié)果判定標(biāo)準(zhǔn)按2012年版《抗微生物學(xué)藥物敏感性試驗(yàn)執(zhí)行標(biāo)準(zhǔn)》規(guī)定執(zhí)行。結(jié)果:2016年1月1日至2016年12月31日共收集痰液標(biāo)本5743份,其中檢出陽(yáng)性標(biāo)本1379份,陽(yáng)性率為24%。各種細(xì)菌檢出率:銅綠假單胞菌22%;鮑曼不動(dòng)桿菌17%;肺炎克雷伯菌肺炎亞種14%;大腸埃希菌10%;肺炎鏈球菌9%;金黃色葡萄球菌金黃亞種8%;卡他摩拉菌4%;白色念珠菌2%;陰溝腸桿菌2%;產(chǎn)氣腸桿菌2%;其它10%。結(jié)論:2016年下呼吸道感染病原菌前五位分別是:銅綠假單胞菌、鮑曼不動(dòng)桿菌、肺炎克雷伯菌肺炎亞種、大腸埃希菌、肺炎鏈球菌。與2015年相比,鮑曼不動(dòng)桿菌的比例有較大提高,肺炎鏈球菌也進(jìn)入到前五位。各種病原菌對(duì)氨芐西林的耐藥率均達(dá)到了80%以上,該抗生素不宜用于臨床治療。在銅綠假單胞菌感染的治療中頭孢吡肟、妥布霉素、左旋氧氟沙星、哌拉西林/他唑巴坦、氨曲南、哌拉西林、慶大霉素、替卡西林/克拉維酸和環(huán)丙沙星的耐藥率效果較好。頭孢他啶、亞胺培南、美洛培南、阿米卡星最有效藥物。鮑曼不動(dòng)桿菌耐藥性分析中發(fā)現(xiàn)其對(duì)幾乎所有抗生素耐藥,且分離出該種菌的標(biāo)本幾乎全部來(lái)自ICU,建議醫(yī)院要加強(qiáng)對(duì)ICU醫(yī)院感染的檢測(cè)。肺炎克雷伯菌的耐藥特性較弱,僅對(duì)氨芐西林的耐藥達(dá)到80%以上。厄他培南、亞胺培南、美洛培南和阿米卡星是治療大腸埃希菌感染的最佳藥物。替卡西林/克拉維酸、哌拉西林/他唑巴坦和頭孢西丁屬于有效藥物。在下呼吸道感染中,各種病原菌的比率會(huì)隨著時(shí)間的推移而發(fā)生變化,其耐藥性也會(huì)反生很大變化,且與抗生素的運(yùn)用原則和頻率有相關(guān)性,應(yīng)加強(qiáng)藥敏監(jiān)測(cè)與分析,及時(shí)的為指導(dǎo)臨床合理運(yùn)用抗生素提供科學(xué)依據(jù)。
[Abstract]:Objective: the research on pathogens of lower respiratory tract infection will be very different with the different investigation area and scope, so this study takes the sputum samples of patients with lower respiratory tract infection in our hospital as the research object, carries on the bacteria culture and the drug sensitivity test.A large number of experimental results were analyzed and summarized. Finally, the latest distribution data and drug resistance characteristics of pathogenic microorganisms in patients with lower respiratory tract infection in our hospital were obtained, and the data were further excavated.By comparing the latest distribution data and drug resistance characteristics with the infection investigation report published by our hospital last year, the changes of the distribution and drug resistance characteristics of pathogenic bacteria were obtained.To provide clinical reference to promote the rational use of antibiotics.Methods: sputum samples from patients with lower respiratory tract infection from January 1, 2016 to December 31, 2016 in our hospital were collected.If there are two kinds of bacteria, the dominant bacteria are selected for identification and drug sensitivity analysis.The bacteriological identification and drug sensitivity test were carried out by using the French Bio-Merier bacteria Identification instrument and DADE BEHRING automatic Microbiological Identification instrument.All strains were identified by traditional biochemical method and K-B method when necessary.The results of drug sensitivity test were determined according to the execution standard of anti-microbiological drug sensitivity test in 2012.Results: from January 1, 2016 to December 31, 2016, a total of 5743 sputum samples were collected, of which 1379 were positive, with a positive rate of 24.Detection rate of various bacteria: Pseudomonas aeruginosa 22; Acinetobacter baumannii 17; Klebsiella pneumoniae subspecies 14; Escherichia coli 10; Streptococcus pneumoniae 9; Staphylococcus aureus gold subspecies 8; Morrah katamora 4; Candida albicans 2;Enterobacter cloacae 2; Enterobacter aerogenes 2; other 10.Conclusion: the top five pathogens of lower respiratory tract infection in 2016 are Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae pneumonia subspecies, Escherichia coli and Streptococcus pneumoniae.Compared with 2015, Acinetobacter baumannii increased significantly, and Streptococcus pneumoniae entered the top five.The resistance rate of various pathogens to ampicillin was more than 80%, and the antibiotic was not suitable for clinical treatment.In the treatment of Pseudomonas aeruginosa infection, cefepime, tobramycin, levofloxacin, piperacillin / tazobactam, aztreonam, piperacillin, gentamicin, tekacillin / clavulanic acid and ciprofloxacin were better.Ceftazidime, imipenem, meropenem, amikacin are the most effective drugs.In drug resistance analysis of Acinetobacter baumannii, it was found that it was resistant to almost all antibiotics, and almost all samples isolated from Acinetobacter baumannii were from ICU. It was suggested that hospital should strengthen the detection of ICU nosocomial infection.The resistance of Klebsiella pneumoniae to ampicillin was more than 80%.Ertapenem, imipenem, meropenem and amikacin are the best drugs for the treatment of Escherichia coli infection.Tecacillin / clavulanic acid, piperacillin / tazobactam and cefoxitin are effective drugs.In the infection of lower respiratory tract, the ratio of various pathogens will change with the passage of time, and the drug resistance will also change greatly, and it is related to the principle and frequency of antibiotic use, so the surveillance and analysis of drug sensitivity should be strengthened.To provide scientific basis for guiding the rational use of antibiotics in clinical practice.
【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;R56

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