本文選題：鮑曼不動(dòng)桿菌　切入點(diǎn)：流行病學(xué)　出處：《蘇州大學(xué)》2007年碩士論文　論文類型：學(xué)位論文

【摘要】： 細(xì)菌的耐藥性是普遍存在的，對(duì)于它的發(fā)展趨勢(shì)，從細(xì)菌本身看，呈現(xiàn)單一耐藥到多重耐藥的趨勢(shì)，從抗菌藥物方面看，呈現(xiàn)低耐藥率到高耐藥率的趨勢(shì)，且發(fā)展速度越來(lái)越快近年來(lái)。由于抗菌藥物的廣泛使用甚至過度使用，鮑曼不動(dòng)桿菌的耐藥性呈總體上升趨勢(shì)，耐藥株迅速增加，并出現(xiàn)了多重耐藥株。為了解鮑曼不動(dòng)桿菌的分布特點(diǎn)，耐藥性變化和醫(yī)院肺部感染危險(xiǎn)因素，正確選用有效的抗菌藥物，對(duì)泰州地區(qū)兩家綜合性醫(yī)院一年來(lái)分離的鮑曼不動(dòng)桿菌引起的院內(nèi)感染及對(duì)13種抗菌藥物的耐藥性作回顧性分析。 目的： 了解泰州地區(qū)兩家綜合性醫(yī)院鮑曼不動(dòng)桿菌的分布特點(diǎn)和耐藥變化，以指導(dǎo)臨床抗生素的合理使用。了解鮑曼不動(dòng)桿菌醫(yī)院肺部感染危險(xiǎn)因素。 方法： 收集了2006年1月-2006年12月從泰州地區(qū)2家醫(yī)院臨床標(biāo)本中分離檢出的116株鮑曼不動(dòng)桿菌。用法國(guó)生物梅里埃公司生產(chǎn)的VITEK32細(xì)菌鑒定系統(tǒng)的G-桿菌鑒定卡(GNI卡)將細(xì)菌鑒定到種；采用其GNS藥敏試驗(yàn)卡測(cè)定最低抑菌濃度(MIC)，進(jìn)行抗生素敏感性試驗(yàn)；按照美國(guó)國(guó)家臨床實(shí)驗(yàn)室標(biāo)準(zhǔn)化委員會(huì)(NCCLS)2005年版的標(biāo)準(zhǔn)判斷結(jié)果，以敏感率、中介率、耐藥率報(bào)告結(jié)果；用世界衛(wèi)生組織細(xì)菌耐藥性監(jiān)測(cè)網(wǎng)提供的WHONET5.4軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析。對(duì)鮑曼不動(dòng)桿菌引發(fā)的醫(yī)院鮑曼不動(dòng)桿菌肺炎45例患者的感染情況進(jìn)行調(diào)查，采用病例對(duì)照研究，了解醫(yī)院鮑曼不動(dòng)桿菌肺炎的危險(xiǎn)因素。 結(jié)果： 1．泰州地區(qū)鮑曼不動(dòng)桿菌醫(yī)院感染率較高，為3.93‰，主要分部在ICU病房，腦外科，燒傷科，呼吸科，老年科，其中ICU病房，腦外科，燒傷科，最常見。ICU病房占感染數(shù)35.3％，腦外科為11.2％，燒傷科為19.0％；藥敏結(jié)果顯示除亞胺培南，頭孢哌酮／舒巴坦外，對(duì)其它抗生素的耐藥率基本在50％以上； 2．危險(xiǎn)因素分別為病情、ICU、免疫抑制劑、氣管切開／插管、抗生素使用種類。 結(jié)論： 1、泰州地區(qū)鮑曼不動(dòng)桿菌已成為醫(yī)院內(nèi)感染和肺部感染的重要病原菌。 2、通過耐藥性分析，我們發(fā)現(xiàn)泰州地區(qū)Ab耐藥現(xiàn)象較嚴(yán)重，且存在多重耐藥情況。本地區(qū)Ab對(duì)推薦的敏感藥物碳青霉烯類耐藥性偏高，應(yīng)引起重視。 3、泰州地區(qū)不同醫(yī)院環(huán)境、不同科室環(huán)境及不同的感染部位，鮑曼不動(dòng)桿菌的細(xì)菌敏感性的分布和耐藥菌株的流行情況不盡相同。鮑曼不動(dòng)桿菌醫(yī)院感染以肺部感染率為最高，，病房分布依次為ICU病房、腦外科、燒傷科、呼吸科。 4、鮑曼不動(dòng)桿菌肺炎的相關(guān)危險(xiǎn)因素的單因素分析顯示，基礎(chǔ)疾病、ICU、氣管切開／插管、抗生素使用種類、免疫抑制劑等是引起鮑曼不動(dòng)桿菌肺炎的主要因素。
[Abstract]:The drug resistance of bacteria is widespread. From the point of view of bacteria itself, there is a tendency of single drug resistance to multidrug resistance, and from the aspect of antibiotics, there is a trend of low drug resistance rate to high drug resistance rate. The drug resistance of Acinetobacter baumannii has been on the rise and the resistant strains have been increasing rapidly due to the widespread use or even overuse of antimicrobial agents in recent years. In order to understand the distribution characteristics of Acinetobacter baumannii, the change of drug resistance and the risk factors of nosocomial pulmonary infection, the effective antimicrobial agents were selected correctly. The nosocomial infection caused by Acinetobacter baumannii isolated from two general hospitals in Taizhou area during the past year and its resistance to 13 antimicrobial agents were analyzed retrospectively. Objective:. To understand the distribution characteristics and drug resistance of Acinetobacter baumannii in two general hospitals in Taizhou to guide the rational use of antibiotics and to understand the risk factors of nosocomial pulmonary infection of Acinetobacter baumannii. Methods:. A total of 116 strains of Acinetobacter baumannii isolated from clinical specimens of two hospitals in Taizhou from January 2006 to December 2006 were collected. Identification of bacteria into species; The GNS drug sensitivity test card was used to determine the minimum inhibitory concentration (MIC) and the antibiotic sensitivity test was carried out according to the results of the National Committee for Standardization of Clinical Laboratories (NCCLS) of 2005, and the results were reported by the sensitivity rate, intermediate rate and drug resistance rate. The data of 45 patients with Acinetobacter baumannii pneumonia caused by Acinetobacter baumannii were investigated by using WHONET5.4 software provided by the World Health Organization bacterial Resistance Surveillance Network. To understand the risk factors of Acinetobacter baumannii pneumonia in hospital. Results:. 1. The nosocomial infection rate of Acinetobacter baumannii in Taizhou area was 3.93 鈥

本文編號(hào)：1626201