本文選題：鮑曼不動桿菌 + 碳青霉烯　； 參考：《中國人民解放軍軍醫(yī)進修學院》2012年碩士論文

【摘要】：1、目的：(1)回顧性分析我院2008-2011年臨床分離的碳青霉烯類耐藥鮑曼不動桿菌(CRAB)所致老年患者醫(yī)院獲得性肺炎(HAP)病例,總結臨床特點、易患因素及鮑曼不動桿菌耐藥表型,為臨床合理應用抗菌藥物提供參考。(2)對CRAB進行體外聯(lián)合藥敏試驗,尋找對CRAB有效的藥物組合。(3)檢測我院CRAB的主要碳青霉烯酶基因型,研究臨床分離的CRAB耐藥機制。 2、方法：(1)制定病例調查表,收集71例CRAB所致老年患者HAP病例的基本情況、既往應用抗生素的種類,基礎疾病,臨床表現(xiàn),藥敏結果及治療轉歸等,尋找易感因素,明確所致感染的臨床特點及預后情況。(2)采用棋盤法設計微量肉湯稀釋法對60株CRAB進行不同藥物組合的體外聯(lián)合抑菌試驗：所選用的抗菌藥物組合包括：頭孢哌酮/舒巴坦(CFS)+利福平(RFP),頭孢哌酮/舒巴坦+米諾環(huán)素(MIN),頭孢哌酮/舒巴坦+美羅培南(MER),頭孢哌酮/舒巴坦+左氧氟沙星(LEV)及美羅培南+米諾環(huán)素,并計算聯(lián)合抑菌指數(shù)(FIC指數(shù)),判斷聯(lián)合效應。(3)收集我院老年病房CRAB60株,用PCR擴增方法檢測60株CRAB的碳青霉烯酶基因型。3、結果：(1)CRAB所致老年患者HAP多發(fā)生在基礎疾病患者,死亡組的APACHE Ⅱ評分(25.78±4.35)明顯高于生存組(18.07±6.5)且P0.05。治療中使用頭孢哌酮/舒巴坦的一組患者的30天生存率明顯高于另一組(P0.05)。(2)CFS與RFP聯(lián)用后,80.0%為協(xié)同作用,16.7%為相加作用,3.3%為無關作用,無拮抗作用；CFS與MIN聯(lián)用后,11.7%為協(xié)同作用,45.0%為相加作用,35.0%為無關作用,8.3%為拮抗作用；CFS與LEV聯(lián)用時,6.7%為協(xié)同作用,40.0%為相加作用,53.3%為無關作用,無拮抗作用。MER與CFS聯(lián)用后,28.3%為協(xié)同作用,53.4%為相加作用,18.3%為無關作用,無拮抗。MER與MIN聯(lián)用后,10.0%為協(xié)同作用,75.0%為相加作用,15.0%為無關作用,無拮抗。各組藥物聯(lián)用后,濃度-累積抑菌百分率曲線均左移。(3)60株CRAB中,擴增出OXA-23及OXA-51基因均為58株(96.7%),同一株菌同時擴增出OXA-23及OXA-51基因的有57株（95.0%），，未增出OXA-24、OXA-58、SIM、VIM IMP耐因。4、結論：（1）CRAB所致老年患者HAP死亡預與APACHEⅡ評分有關；CFS治療CRAB老年HAP有一定療效。（2）CFS與RFP、MIN、MER MER與MIN聯(lián)用時對CRAB效應主表現(xiàn)為協(xié)同和加作用。CFS與LEV聯(lián)用主表現(xiàn)為無關作用,但有一部分表現(xiàn)為協(xié)同和加作用。（3）我院流行CRAB碳青 烯因型主為OXA-23和OXA-51型。
[Abstract]:Objective: to analyze retrospectively the clinical characteristics, susceptible factors and phenotype of Acinetobacter baumannii in the elderly patients with nosocomial pneumonia caused by carbapenem resistant Acinetobacter baumannii (CRA) from 2008 to 2011 in our hospital. To provide a reference for the rational use of antimicrobial agents in clinic, combined drug sensitivity test for CRAB in vitro was carried out to find out the effective combination of carbapenem genotypes of CRAB in our hospital, and to study the mechanism of CRAB resistance in clinical isolation. 2. Methods A case questionnaire was made to collect the basic information of 71 cases of HAP caused by CRAB, the kinds of antibiotics, the basic diseases, the clinical manifestations, the results of drug sensitivity and the outcome of treatment, and to find out the susceptible factors. To determine the clinical characteristics and prognosis of the infection. (2) A chessboard method was used to design a broth dilution method for the in vitro combined bacteriostatic test of 60 CRAB strains with different drug combinations. The antimicrobial combinations selected included: cefoperazone. / sulbactam CFS) rifampicin, cefoperazone / sulbactam minocycline, cefoperazone / sulbactam meropenem, cefoperazone / sulbactam levofloxacin, LEV) and meropenem minocycline, The CRAB60 strains in geriatric wards were collected and detected by PCR amplification method. The results showed that the HAP of 60 CRAB strains were mostly found in the patients with basic diseases. The APACHE 鈪

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