本文選題：鮑曼不動桿菌 + 耐藥��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過分析我院鮑曼不動桿菌(Acinetobacter baumannii,Ab)顱內(nèi)感染患者的臨床特點、腦脊液(Cerebro-Spinal Fluid,CSF)生化指標(biāo),探討鮑曼不動桿菌耐藥情況及治療預(yù)后情況,為臨床抗感染防治提供可靠的理論依據(jù)。方法:查閱安徽醫(yī)科大學(xué)第一附屬醫(yī)院各科室2013年9月-2016年9月腦脊液鮑曼不動桿菌感染病例檔案,收集患者的基本資料、發(fā)病特點、腦脊液常規(guī)及生化檢查和臨床微生物藥敏檢測報告,去除假陽性及可能污染病例,采用細(xì)菌耐藥監(jiān)測網(wǎng)軟件WHONET 5.6和SPSS 16.0進(jìn)行統(tǒng)計學(xué)分析。結(jié)果:1.我院腦脊液培養(yǎng)陽性的病原菌種類繁多,其中革蘭氏陰性菌170株(占66.1%),革蘭氏陽性菌73株(占28.4%),真菌14株(占5.5%)。其中鮑曼不動桿菌所占比例最大,共91株(占35.4%),91株共來自于39例鮑曼不動桿菌腦膜炎患者。2.鮑曼不動桿菌感染引發(fā)的細(xì)菌性腦膜炎在我院科室分布較為廣泛,其中以神經(jīng)外科(69.2%)、重癥監(jiān)護(hù)病室(Intensive Care Unit,ICU)(20.5%)和神經(jīng)內(nèi)科(7.7%)較多見。3.本次調(diào)查共39例最終確診為鮑曼不動桿菌感染腦膜炎患者,均接受過神經(jīng)外科手術(shù)或其他顱腦侵入操作,臨床特點如下:年齡2-76歲,平均(46.31±16.41);性別(男27人,女12人)。原發(fā)性疾病主要有腦出血(48.7%)、顱腦意外(38.5%)、腦腫瘤(10.3%);基礎(chǔ)疾病主要為高血壓(35.9%)、糖尿病(10.3%);幾乎所有患者均有不同程度的發(fā)熱和頭痛,絕大多數(shù)患者表現(xiàn)為意識障礙(87.2%),有相當(dāng)數(shù)量癲癇發(fā)作患者(41.0%)。4.腦脊液檢測結(jié)果中白細(xì)胞計數(shù)明顯升高(4652.48±9765.32)*106/L;紅細(xì)胞計數(shù)多(2384.17±6576.74)*106/L;多形核比占(90.18±7.94%);CL-含量偏低(111.12±8.12)mmol/l;蛋白定量升高(3.05±1.29)g/l;葡萄糖含量降低(2.27±1.06)mmol/l。5.39名患者腦脊液標(biāo)本中共分離培養(yǎng)出91株鮑曼不動桿菌,對28種我院常用抗菌藥物出現(xiàn)不同程度耐藥,其中阿米卡星耐藥率(51.95%)、米諾環(huán)素耐藥率(32.65%)、替加環(huán)素耐藥率(43.4%)和頭孢哌酮/舒巴坦耐藥率(47.83%),耐藥率較低。常用抗菌藥物美羅培南耐藥率高達(dá)(90.91%)。6.39例鮑曼不動桿菌腦膜炎患者在腦脊液病原學(xué)結(jié)果公布前,均根據(jù)患者臨床表現(xiàn)的嚴(yán)重程度及腦脊液常規(guī)和生化結(jié)果進(jìn)行經(jīng)驗性抗感染治療,以美羅培南或三代頭孢聯(lián)合萬古霉素治療較多見。其中單一使用三、四代頭孢的患者有6例,三、四代頭孢聯(lián)合萬古霉素抗感染治療8例,美羅培南聯(lián)合萬古霉素13例,其他治療12例。顱內(nèi)感染患者多數(shù)行腦脊液引流術(shù),主要以腰大池引流及側(cè)腦室引流為主,部分患者行皮瓣下引流等,有4例患者因腰大池引流管堵塞而改為側(cè)腦室引流,有3例患者因顱內(nèi)感染控制持續(xù)性腦積水而行永久性腦室腹腔內(nèi)引流術(shù)。腦脊液病原學(xué)及藥敏結(jié)果發(fā)布后,則根據(jù)藥敏結(jié)果及患者臨床癥狀,以美羅培南為主的聯(lián)合治療有10例、亞胺培南為4例、替加環(huán)素為8例、頭孢哌酮舒巴坦為10例、頭孢曲松為5例。7.39名鮑曼不動桿菌腦膜炎患者經(jīng)我院治療,痊愈8名(20.5%)、顯效6名(15.4%)、有效7名(18.0%)、無效18名(46.1%)。結(jié)論:鮑曼不動桿菌腦膜炎多發(fā)生在神經(jīng)外科顱腦侵入性操作后,臨床癥狀重,鮑曼不動桿菌耐藥率高,對常用抗菌藥物普遍耐藥,感染防治形勢格外嚴(yán)峻。加強(qiáng)臨床管理,進(jìn)行細(xì)菌耐藥性監(jiān)測,采用合理用藥,以減少耐藥菌的產(chǎn)生。
[Abstract]:Objective: through the analysis of the clinical characteristics of Acinetobacter baumannii (Acinetobacter baumannii, Ab) and the biochemical indexes of cerebrospinal fluid (Cerebro-Spinal Fluid, CSF) in our hospital, the drug resistance of Acinetobacter and the prognosis of the treatment were discussed in order to provide a reliable theoretical basis for the prevention and treatment of anti infection in the clinic. A case file of the cerebrospinal fluid (CSF) Acinetobacter Bauman infection in every department of the Affiliated Hospital in September 2013 -2016 September, collecting the basic data of the patients, the characteristics of the disease, the routine and biochemical examination of cerebrospinal fluid and the clinical microbiological drug sensitivity test report, removing false positive and possible pollution cases, using the bacterial resistance monitoring network software WHONET 5.6 and SPSS 16. Results: 1. there were a wide variety of pathogenic bacteria in the CSF culture of our hospital, including 170 Gram-negative bacteria (66.1%), 73 Gram-positive bacteria (28.4%) and 14 fungi (5.5%). Among them, the proportion of Acinetobacter Bauman was the largest, 91 (35.4%) and 91 strains of.2. Bauman from the patients with Acinetobacter Bauman meningitis. Bacterial meningitis caused by Acinetobacter infection was widely distributed in the Department of our hospital, including Department of Neurosurgery (69.2%), Intensive Care Unit, ICU (20.5%) and neurology department (7.7%), which were most seen in this investigation, and 39 cases were finally confirmed by Acinetobacter Bauman infected meningitis patients, all accepted the Department of neurosurgery operation or The clinical features of other craniocerebral invasion were as follows: age 2-76 years, average (46.31 + 16.41), sex (27 men and 12 women). Primary diseases were mainly cerebral hemorrhage (48.7%), craniocerebral accident (38.5%), brain tumor (10.3%), basic disease mainly hypertension (35.9%), diabetes (10.3%), almost all patients had different degrees of fever and headache. Most of the patients were characterized by disturbance of consciousness (87.2%), and there was a significant number of epileptic seizures (41%) in.4. cerebrospinal fluid (4652.48 + 9765.32) *106/L, red blood cell count (2384.17 + 6576.74) *106/L, polymorphonuclear nucleus ratio (90.18 + 7.94%), CL- content (111.12 + 8.12) mmol/l, and protein quantitative elevation (3.05 + 1.29). G/l, 91 strains of Acinetobacter Bauman were isolated and cultured in cerebrospinal fluid samples of mmol/l.5.39 patients with glucose content reduction (2.27 + 1.06). The resistance rate of 28 kinds of antibiotics used in our hospital was different, including the Amikacin resistance rate (51.95%), the resistance rate of minocycline (32.65%), tetracycline resistance rate (43.4%) and Cefoperazone / sulbactam resistance Rate (47.83%), the resistance rate was low. The common antimicrobial drug meropenem resistance rate was high (90.91%).6.39 cases of Acinetobacter meningomeningitis patients in the cerebrospinal fluid pathogeny before the release of the patient's clinical manifestations of the severity and cerebrospinal fluid routine and biochemical results of the experimental anti infection treatment, with meropenem or three generation of cephalosporin. Three, four generation cephalosporin had 6, three, four cephalosporin combined with vancomycin, 8, 13, and 12. Most of the patients were treated with cerebrospinal fluid drainage, mainly with large pool drainage and lateral ventricle drainage. 4 patients were replaced by lateral ventricle drainage because of the blockage of the drainage tube of the lumbar and large pools, and 3 patients underwent permanent ventricle intraperitoneal drainage because of the intracranial infection controlling persistent hydrocephalus. After the cerebrospinal fluid etiology and drug sensitivity results were released, the combined treatment of meropenem based on the results of drug sensitivity and the clinical symptoms of the patients. There were 10 cases, 4 imipenem, 8 cases of tegoperazin, 10 cases of cefoperazone sulbactam, 5 cases of ceftriaxone (.7.39) patients with.7.39 meningitis, 8 (20.5%), 6 (15.4%), 7 (18%) and invalid (46.1%). Conclusion: Acinetobacter meningomeningitis in the Department of Neurosurgery mostly occurred in the Department of Neurosurgery invade craniocerebral invasion After the operation, the clinical symptoms are heavy, the drug resistance rate of Acinetobacter Bauman is high and the common antibiotics are generally resistant. The prevention and treatment situation of the infection is particularly severe.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R742.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 車洋;楊天池;平國華;林律;;寧波地區(qū)耐多藥結(jié)核分枝桿菌鏈霉素耐藥相關(guān)基因rpsL和rrs突變研究[J];中國預(yù)防醫(yī)學(xué)雜志;2016年10期

2 郭杵強(qiáng);;神經(jīng)外科ICU耐藥鮑曼不動桿菌顱內(nèi)感染的治療[J];中國實用醫(yī)藥;2016年19期

3 陳紅偉;婁元華;李小勇;潘棟超;解東成;劉東升;;替加環(huán)素聯(lián)合頭孢哌酮/舒巴坦治療耐藥鮑曼不動桿菌顱內(nèi)感染臨床研究[J];中國感染控制雜志;2016年06期

4 楊婧;趙斌;李曉紅;于笑難;;術(shù)后顱內(nèi)感染菌種分布、危險因素與結(jié)局分析[J];東南國防醫(yī)藥;2016年03期

5 路愛麗;;腦脊液細(xì)胞學(xué)檢測在中樞神經(jīng)系統(tǒng)感染性疾病中的意義[J];中國實用醫(yī)藥;2016年12期

6 朱陣;曹明澤;張吉麗;周緒正;李冰;張繼瑜;;細(xì)菌耐藥性研究進(jìn)展[J];中國畜牧獸醫(yī);2015年12期

7 韋志友;丁軍穎;劉清泉;;β-內(nèi)酰胺酶耐藥機(jī)制及其中醫(yī)藥相關(guān)研究進(jìn)展[J];解放軍醫(yī)藥雜志;2015年10期

8 王娜;楊曉洪;郭欣妍;陳彪;葉波平;葛峰;;磺胺類耐藥菌中抗性基因sul的表達(dá)規(guī)律[J];生態(tài)毒理學(xué)報;2015年05期

9 黃青;殷俊;陳曦;馬雪嬌;劉艷艷;葉英;許夕海;李家斌;;β-溶血性鏈球菌紅霉素耐藥特征與大環(huán)內(nèi)酯類耐藥基因的分析[J];中國抗生素雜志;2015年09期

10 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;倪語星;孫景勇;褚云卓;田素飛;胡志東;李金;俞云松;林潔;單斌;杜艷;韓艷秋;郭素芳;魏蓮花;吳玲;張泓;孔菁;胡云建;艾效曼;卓超;蘇丹虹;;2014年CHINET中國細(xì)菌耐藥性監(jiān)測[J];中國感染與化療雜志;2015年05期

相關(guān)博士學(xué)位論文 前2條

1 張若文;燒傷病房耐碳青霉烯類銅綠假單胞菌耐藥機(jī)制及分子流行病學(xué)研究[D];吉林大學(xué);2012年

2 袁敏;氨基糖苷類抗生素對重組鈍化酶的穩(wěn)定性及耐藥分子機(jī)理研究[D];北京協(xié)和醫(yī)學(xué)院;2011年

相關(guān)碩士學(xué)位論文 前5條

1 王燕;人工誘導(dǎo)空腸彎曲菌紅霉素耐藥株的生物學(xué)特性及蛋白質(zhì)組學(xué)分析[D];揚州大學(xué);2013年

2 李恒德;脊柱結(jié)核分枝桿菌鏈霉素耐藥株篩選及其耐藥機(jī)制初步探討[D];南華大學(xué);2013年

3 張倫軍;銅綠假單胞菌的耐藥性及β-內(nèi)酰胺酶耐藥基因的研究[D];安徽醫(yī)科大學(xué);2013年

4 游洋;鮑曼不動桿菌生物膜形成與耐藥的相關(guān)性研究[D];天津醫(yī)科大學(xué);2012年

5 陳佳紅;常見革蘭陰性桿菌耐藥性和消毒劑—磺胺耐藥基因的檢測及分析[D];青島大學(xué);2012年

，

本文編號：2117534