發(fā)布時間：2018-04-16 09:36

  本文選題：綠膿桿菌 + 感染��； 參考：《遵義醫(yī)學院》2017年碩士論文

【摘要】：目的:分析泌尿系置管患者發(fā)生綠膿桿菌感染的相關(guān)危險因素,并探討感染綠膿桿菌患者的耐藥情況。方法:統(tǒng)計2015年1月至2017年1月在我科行泌尿系置管的2012例患者的病歷資料,其中發(fā)生綠膿桿菌感染的患者62例。記錄、分析與泌尿系置管后發(fā)生綠農(nóng)桿菌感染的相關(guān)的因素,對感染發(fā)生有關(guān)的各種相關(guān)因素進行單因素分析(χ~2檢驗)和多因素Logistic回歸分析,并統(tǒng)計綠膿桿菌感染患者耐藥種類及耐藥率狀況。結(jié)果:多因素Logistic回歸分析結(jié)果顯示大于60歲(VS小于等于60歲),OR=3.041,95%CI(1.623-5.699)、留置管時間超過1月(VS留置置管時間小于等于1月),OR=2.889,95%CI(1.380-6.048)、術(shù)前腎功能受損(VS術(shù)前無腎功能受損),OR=7.111,95%CI(3.470-14.575)、合并低蛋白血癥(VS無低蛋白血癥OR=5.044),95%CI(2.274-11.187))、糖尿病基礎(chǔ)病史(VS無糖尿病基礎(chǔ)病史)OR=4.303,95%CI(1.416-13.074)、體外置管方式(VS體內(nèi)置管方式),OR=12.987,95%CI(6.667-25.000)是泌尿系置管患者發(fā)生綠膿桿菌感染的獨立危險因素。將留置體外置管三種方式綠膿桿菌感染率進行整體卡方檢驗及分割卡方檢驗,結(jié)果顯示留置腎造瘺管(VS導(dǎo)尿管組,χ~2=15.26,P=0.000);(VS膀胱造瘺管,χ~2=18.41,P=0.000)發(fā)生泌尿系綠膿桿菌感染的機會更高。細菌培養(yǎng)+20種抗生素藥物敏感試驗結(jié)果表明:藥物耐藥情況為綠膿桿菌對頭孢類中頭孢唑啉(耐藥率100%)、頭孢呋辛鈉(耐藥率98%)、頭孢呋辛酯(耐藥率98%)、頭孢曲松(耐藥率98%);青霉素類中氨芐西林(耐藥率100%)、氨芐西林/舒巴坦(耐藥率100%);其他β-內(nèi)酰胺類中頭孢替坦(耐藥率90%);硝基呋喃類中呋喃妥因(耐藥率90%);磺胺類中復(fù)方新諾明(耐藥率98%)明顯耐藥。藥物敏感情況為綠膿桿菌僅對氨基糖甙類中的丁胺卡那霉素(敏感率94%)、慶大霉素(敏感率71%)、妥布霉素(敏感率77%);喹諾酮類中環(huán)丙沙星(敏感率61%)、左氧氟沙星(敏感率65%);頭孢類中的頭孢他啶(敏感率84%)、頭孢吡肟(敏感率74%);半合成青霉素類中哌拉西林/他唑巴坦(敏感率80%)、氧哌嗪青霉素(敏感率74%)以及碳青酶烯類抗生素中美羅培能(敏感率77%)、亞胺硫霉素(泰能)(敏感率94%)敏感。結(jié)論:高齡(大于60歲)、合并腎功能受損、低蛋白血癥、糖尿病的患者是泌尿系置管患者發(fā)生綠膿桿菌感染的高危人群,行泌尿系體外置管尤其是留置腎造瘺管,且置管時間超過一個月的患者發(fā)生綠膿桿菌感染幾率顯著增加;泌尿系置管患者綠膿桿菌感染的耐藥情況極其嚴峻,臨床治療中務(wù)必重視這些危險因素并根據(jù)藥敏情況合理使用抗生素。
[Abstract]:Objective: to analyze the risk factors of Pseudomonas aeruginosa infection in patients with urinary tract catheterization and to explore the drug resistance of patients with Pseudomonas aeruginosa infection.Methods: the medical records of 2012 patients with urinary tract catheterization in our department from January 2015 to January 2017 were analyzed, including 62 patients with Pseudomonas aeruginosa infection.The factors related to the infection of Agrobacterium aeruginosa after catheterization of urinary system were recorded and analyzed. Univariate analysis (蠂 ~ 2 test) and multivariate Logistic regression analysis were carried out.The drug resistance types and drug resistance rate of patients with Pseudomonas aeruginosa infection were analyzed.The risk factors of infection of Pseudomonas aeruginosa in patients with urinary tract catheterization were as follows: proteinemia: 5.044 / 95CI2.274-11.1877; basic history of diabetes: no basic history of diabetes: OR4.303 ~ 95CI1.416-13.074; in vitro catheterization: OR12.98795CI6.667-25.000) in patients with urinary tract catheterization, the infection of Pseudomonas aeruginosa was found to be an independent risk factor for infection of Pseudomonas aeruginosa in patients with urinary tract catheterization.The infection rate of Pseudomonas aeruginosa in three ways of indwelling external tube was tested by chi-square test and segmented chi-square test. The results showed that there was a higher chance of urinary tract infection caused by Pseudomonas aeruginosa infection in the group of catheterization plus vs urethral catheterization, 蠂 ~ 2 ~ (2 +) ~ (15.26) P ~ (0.000) and vitreostomy (蠂 ~ (2) ~ (2)) ~ (18. 41) P ~ (0.000)).The results of 20 antibiotic susceptibility tests showed that the drug resistance of Pseudomonas aeruginosa to cefazolin (100%), cefuroxime sodium (98%), cefuroxime (98%) and cefuroxime (98%, ceftriaxone)Ampicillin in penicillin, ampicillin in penicillin, ampicillin / sulbactam, ceftitan in other 尾-lactams, nitrofurantoin, sulbactam and sulfamideThe drug resistance rate was 98%.Ceftazidime in ceftazidime, cefepime in ceftazidime, piperacillin / tazobactam in semi-synthetic penicillin, piperacillin / tazobactam in semi-synthetic penicillin.Meropenem (sensitivity: 77g), imidulfycin (tianeng) (sensitivity: 94kb).Conclusion: the patients with advanced age (> 60 years old, complicated with impaired renal function, hypoproteinemia and diabetes mellitus) are the high risk group for infection of Pseudomonas aeruginosa in patients with urinary tract catheterization, especially indwelling renal fistula tube.The incidence of Pseudomonas aeruginosa infection was significantly increased in patients with tube placement for more than one month, and the drug resistance of patients with urinary tract catheterization was extremely severe.These risk factors must be taken seriously in clinical treatment and antibiotics should be used reasonably according to drug sensitivity.
【學位授予單位】：遵義醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R691.3

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