本文選題：燒傷 + 病原菌��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:了解我科2010-2014年臨床分離細(xì)菌分布及耐藥情況,了解近期鮑曼不動(dòng)桿菌耐藥基因情況,從而為臨床有效控制感染、使用抗菌藥物提供依據(jù)。方法:對(duì)2010年至2014年5年間入住本院燒傷病房并送檢且培養(yǎng)結(jié)果陽(yáng)性患者的臨床資料進(jìn)行回顧性分析。對(duì)臨床收集的鮑曼不動(dòng)桿菌,隨機(jī)選取50株,采用PCR方法檢測(cè)其9種常見(jiàn)耐藥基因:bla KPC、bla IMP、bla VIM、bla NDM-1、bla OXA-23、bls OXA-24、bla OXA-48、bla OXA-51和bla OXA-58。結(jié)果:調(diào)查結(jié)果顯示,燒傷因素和性別(χ2=24.318,P0.001)本次樣本量?jī)?nèi)有統(tǒng)計(jì)學(xué)意義;燒傷程度與住院時(shí)間具有統(tǒng)計(jì)學(xué)意義(χ2=3,P0.05)。與此同時(shí),菌株來(lái)源與病原菌分布同樣具有顯著統(tǒng)計(jì)學(xué)意義(χ2=29.632,P0.005),且檢出部位前兩位均為創(chuàng)面與分泌物。5年間共分離細(xì)菌542株中,相較革蘭陽(yáng)性菌(16.6%),2010-2014經(jīng)統(tǒng)計(jì)學(xué)分析,呈遞減趨勢(shì);革蘭陰性菌(83.39%)多見(jiàn)。兩類檢出率首位的耐藥率不容樂(lè)觀。43.9%銅綠假單胞菌對(duì)頭孢哌酮/舒巴坦耐藥。葡萄球菌屬中:奎奴普丁(1.27%)、復(fù)方新諾明(27.85%)和氯霉素(27.85%)敏感性較好外,兩菌其余藥物耐藥率均大于50%。50株臨床分離的鮑曼不動(dòng)桿菌大多來(lái)自危重患者痰液標(biāo)本;除美羅培南(17.20%),已對(duì)其余常用藥物耐藥率高達(dá)70%以上�？紤]到年齡因素分組后,在革蘭陽(yáng)性菌中,金黃色葡萄球菌為嬰幼兒組(13/19,68.42%)和兒童組(4/4,100%)的主要優(yōu)勢(shì)菌種。在革蘭陰性菌中銅綠假單胞菌為三組中主要優(yōu)勢(shì)菌種,兒童組中比重顯著大于(17/31,54.84%)嬰幼兒組和成人組,后兩組中其構(gòu)成比無(wú)顯著差異。金葡菌和其余革蘭陽(yáng)性菌普遍耐藥率較高,嬰幼兒組耐藥率基本高于成人組水平。合成青霉素哌拉西林中,兒童耐藥率(56.25%)顯著小于其余兩組。對(duì)50株鮑氏不動(dòng)桿菌進(jìn)行耐藥基因篩查,經(jīng)PCR分析發(fā)現(xiàn),檢出率最高為bla OXA-51-like基因(68.30%);其次為bla OXA-23-like基因,檢出率32.79%。兩類基因在多重耐藥鮑曼不動(dòng)桿菌的檢出率均為非多重耐藥菌兩倍左右。檢出bla OXA-58-like一株,但為非多重耐藥菌。結(jié)論:革蘭陽(yáng)性菌感染率下降,銅綠假單胞菌和葡萄球菌屬耐藥性增加,主要與萬(wàn)古霉素和二線利奈唑胺使用以及早期削痂策略有關(guān),而兒童檢出革蘭陽(yáng)性菌高可能與兒童很少使用萬(wàn)古霉素和利奈唑胺有關(guān),建議根據(jù)藥敏結(jié)果合理選用抗菌藥物。鮑曼不動(dòng)桿菌以呼吸道傳播為主,其較高的耐藥率形勢(shì)已十分嚴(yán)峻,碳青霉烯耐藥基因主要以bla OXA-23,bla OXA-51耐藥基因?yàn)橹?多重耐藥菌的流行也與之相關(guān)。
[Abstract]:Objective: to understand the distribution and drug resistance of clinical isolates in our department for 2010-2014 years, to understand the recent drug resistance gene of Acinetobacter Bauman, so as to provide the basis for the effective control of infection and the use of antibiotics. Methods: the clinical data of the patients who were admitted to the hospital from 2010 to 2014 and were checked and cultured for the positive patients in the hospital for 5 years. A retrospective analysis was performed. 50 strains of Acinetobacter Bauman were randomly selected and 9 common resistance genes were detected by PCR method: bla KPC, BLA IMP, BLA VIM, BLA NDM-1, BLA OXA-23. Statistical significance, the degree of burn and the time of hospitalization were statistically significant (x 2=3, P0.05). At the same time, the source of the strain and the distribution of pathogenic bacteria were equally significant (x 2=29.632, P0.005), and the first two of the detected sites were all 542 strains of bacteria separated from the wound and secretions during.5, compared with the Gram-positive bacteria (16.6%) and 2010-2014 Study analysis, subtraction trend, Gram-negative bacteria (83.39%) were more common. The drug resistance rate at the first of class two detection rates was not optimistic..43.9% Pseudomonas aeruginosa was resistant to Cefoperazone / sulbactam. In the genus Staphylococcus, quetiapin (1.27%), compound neorammine (27.85%) and chloramphenicol (27.85%) were more sensitive than 50, and the drug resistance rates of the other two bacteria were more than 50. The clinical isolates of%.50 strains of Acinetobacter from%.50 were mostly from the sputum of critically ill patients. In addition to meropenem (17.20%), the drug resistance rate of the other commonly used drugs was up to 70%. Considering the age group, Staphylococcus aureus was the main dominant strain in 13/19,68.42% and 4/4100%. Pseudomonas aeruginosa in Gram-negative bacteria was the main dominant strain in three groups. The proportion of children in children group was significantly greater than that of (17/31,54.84%) infant group and adult group, and there was no significant difference in the composition ratio in the latter two groups. The resistance rate of Staphylococcus aureus and other Gram-positive bacteria was higher than that in the adult group. In piperacillin, the resistance rate of children (56.25%) was significantly smaller than the other two groups. 50 strains of Acinetobacter baumannii was screened. The highest detection rate was bla OXA-51-like gene (68.30%) by PCR analysis, followed by bla OXA-23-like gene, and the detection rate of 32.79%. two genes in multidrug resistant Acinetobacter was not much more. BLA OXA-58-like was found to be about two times. A strain was detected, but it was non multidrug-resistant bacteria. Conclusion: the infection rate of Gram-positive bacteria decreased, the resistance of Pseudomonas aeruginosa and Staphylococcus increased, mainly related to the use of vancomycin and linezolid, and early eschar cutting strategy, and the detection of Gram-positive bacteria in children was likely to be very high with children. Less use of vancomycin and linezolid, it is suggested that antimicrobial agents should be selected rationally according to the results of drug sensitivity. Acinetobacter sp. Bauman is mainly with respiratory tract transmission, and its high drug resistance rate is very severe. The resistance genes of carbapenems are mainly bla OXA-23, BLA OXA-51 resistant basis, and the prevalence of multidrug-resistant bacteria is also related.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R644;R446.5

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