本文選題：燒傷 + 感染��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:分析我院燒傷科患者感染病原菌分布和耐藥性及其變遷,以便指導(dǎo)臨床用藥。方法:收集2010年1月至2014年12月石家莊河北友愛醫(yī)院燒傷科888例燒傷患者病原菌感染標(biāo)本,進(jìn)行細(xì)菌培養(yǎng)。采用全自動微生物鑒定系統(tǒng)進(jìn)行細(xì)菌鑒定。采用K-B紙片法進(jìn)行藥物敏感試驗。統(tǒng)計各年份病原菌檢出分布和主要菌群的耐藥性情況。結(jié)果:1 2010至2014年,我院燒傷患者送檢標(biāo)本病原菌檢出率波動在30%左右,其中分離率居前五位依次為銅綠假單胞菌(36.71%)、金黃色葡萄球菌(22.86%)、大腸埃希菌(14.86%)、肺炎克雷伯菌(8.22%)和鮑曼不動桿菌(6.31%)。2銅綠假單胞菌整體檢出率一直居高不下。金黃色葡萄球菌檢出率2013年開始稍有下降趨勢(P0.05)。金黃色葡萄球菌中耐甲氧西林的金黃色葡萄球菌(MRSA)檢出率呈逐年遞增的趨勢(P0.01)。甲氧西林敏感的金黃色葡萄球菌(MSSA)檢出率在5年間的變化差異無統(tǒng)計學(xué)意義。大腸埃希菌檢出率自2010年以來有下降的趨勢(P0.05)。肺炎克雷伯菌檢出率在2014年有明顯升高的趨勢(P0.01),超過鮑曼不動桿菌檢出率。3銅綠假單胞菌的耐藥性自2012年以后呈逐年下降的趨勢(P0.05),僅對環(huán)丙沙星和哌拉西林/他唑巴坦的耐藥率呈逐年增高的趨勢(P0.05)。鮑曼不動桿菌對頭孢菌素、碳?xì)涿赶╊惡铜h(huán)丙沙星表現(xiàn)為較高的耐藥性,對哌拉西林、哌拉西林/他唑巴坦、美羅培南和環(huán)丙沙星的耐藥率均80%,僅對氨基糖苷類和四環(huán)素類藥物敏感。大腸埃希菌對氨芐西林、頭孢唑林和慶大霉素耐藥率均80%,對其他類抗生素耐藥性較低,但仍呈逐年增長的趨勢(P0.05)。肺炎克雷伯菌的耐藥情況相比其他主要病原菌來說較為樂觀,僅對頭孢呋辛和頭孢唑林的耐藥率較高,其他抗菌藥物仍有較好的敏感性。4 2010-2014年MRSA耐藥率均為100%的有3種,包括青霉素、苯唑西林和復(fù)方新諾明,耐藥率80%的抗生素有8種,但MRSA對環(huán)丙沙星、左氧氟沙星和慶大霉素的耐藥性呈逐年遞減的趨勢(P0.05),尚未發(fā)現(xiàn)利奈唑胺、萬古霉素的耐藥菌株。MSSA對青霉素和復(fù)方新諾明的耐藥率80%,其次是紅霉素和克林霉素,耐藥率20%的抗生素有6種,包括苯唑西林、慶大霉素、環(huán)丙沙星、左氧氟沙星、利奈唑胺和萬古霉素。結(jié)論:石家莊河北友愛醫(yī)院燒傷科患者感染主要以銅綠假單胞菌感染和金黃色葡萄球菌感染為主,根據(jù)五年來的藥敏結(jié)果和耐藥性變遷情況正確選擇有效抗菌藥物進(jìn)行治療,對減少細(xì)菌耐藥性的發(fā)生有重要意義。
[Abstract]:Objective: to analyze the distribution, drug resistance and changes of the pathogenic bacteria in the burn patients in our hospital in order to guide the clinical use. Methods: 888 specimens of the pathogenic bacteria infected by the burn patients from January 2010 to December 2014 in Hebei Friendship Hospital, Shijiazhuang, were collected and the bacteria were cultured. The bacterial identification was carried out by the automatic microbial identification system. The drug sensitivity test was carried out by K-B paper method. The distribution of pathogenic bacteria in each year and the drug resistance of major groups were analyzed. Results: from 12010 to 2014, the detection rate of pathogenic bacteria in the burned patients in our hospital fluctuated in about 30%, of which the top five were Pseudomonas aeruginosa (36.71%) and Staphylococcus aureus (22.86%). The overall detection rate of Escherichia coli (14.86%), Klebsiella pneumoniae (8.22%) and Acinetobacter Bauman (6.31%).2 Pseudomonas aeruginosa remained high. The detection rate of Staphylococcus aureus began to decrease slightly in 2013 (P0.05). The detection rate of Staphylococcus aureus (MRSA) in methicillin resistant Staphylococcus aureus was increasing year by year. (P0.01) there was no significant difference in the detection rate of methoxicillin sensitive Staphylococcus aureus (MSSA) in 5 years. The detection rate of Escherichia coli has declined since 2010 (P0.05). The detection rate of Klebsiella pneumoniae increased significantly in 2014 (P0.01), exceeding the detection rate of Acinetobacter Bauman.3 of Pseudomonas aeruginosa The drug resistance was decreasing year by year since 2012 (P0.05). The resistance rate of ciprofloxacin and piperacillin / tazobactam increased year by year (P0.05). Acinetobacter Bauman showed high resistance to cephalosporin, alkenes and ciprofloxacin, and piperacillin, piperacillin / tazobactam, meropenem and meropenem. The drug resistance rate of ciprofloxacin is 80%, only sensitive to aminoglycosides and tetracycline. The resistance rate of Escherichia coli to ampicillin, cefazolin and gentamicin is 80%, and the resistance to other antibiotics is low, but it is still increasing year by year (P0.05). To be optimistic, the drug resistance rate of cefuroxime and cefazolin was higher only. Other antibiotics still had good sensitivity to.4 2010-2014 year MRSA resistance rate of 3 species, including penicillin, oxacillin and compound sulfamethoxazole, and the antibiotic resistance rate 80% were 8, but MRSA was resistant to ciprofloxacin, levofloxacin and gentamicin. A trend of decreasing year by year (P0.05), linezolid was not found, the resistance rate of vancomycin resistant strain.MSSA to penicillin and compound penicillin was 80%, followed by erythromycin and clindamycin, and 6 kinds of antibiotics, including oxacillin, gentamicin, ciprofloxacin, levofloxacin, linezolid and vancomycin. The infection in the Department of burn department of Hebei Friendship Hospital in Shijiazhuang is mainly infected by Pseudomonas aeruginosa and Staphylococcus aureus. It is of great significance to reduce the occurrence of bacterial resistance according to the results of drug sensitivity and the change of drug resistance in the past five years.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R446.5;R644

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