本文選題：革蘭陰性菌　切入點(diǎn)：ESBL　出處：《大連醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：本研究的目的是以大連市兒童醫(yī)院呼吸病房住院患兒為對象，，了解其鼻咽部革蘭陰性菌攜帶的分布，監(jiān)測產(chǎn)ESBL革蘭氏陰性桿菌的流行以及藥物敏感狀況，為臨床提供合理使用抗生素的依據(jù)。 方法：選擇入住大連市兒童醫(yī)院患者有呼吸系統(tǒng)感染的患者進(jìn)行預(yù)期的一年研究，時(shí)間2010年1月到2010年12月。隨機(jī)選取1190例住院患者進(jìn)行咽拭子培養(yǎng)，所有標(biāo)本在巧克力培養(yǎng)基上進(jìn)行微生物培養(yǎng)，應(yīng)用革蘭氏染色和標(biāo)準(zhǔn)化測定分離鑒別的菌落。產(chǎn)ESBL酶革蘭氏陰性菌分離，抗微生物敏感性應(yīng)用K-B法測定進(jìn)行。 結(jié)果：1190例患兒中，男性患兒764例（64.2%），女性426例（35.8%）。208例患兒咽部檢出革蘭陰性菌定植，陽性率17.5%（208/1190），有18種菌株，主要包括鮑曼不動(dòng)桿菌21.2%（44/208），大腸桿菌19.2%（40/208），肺炎克雷伯桿菌12.5%（26/208），流感嗜血桿菌12%（25/208），綠膿桿菌11.1%（23/208），產(chǎn)ESBLS菌株10.1%（21/208），混合感染者9.6%（20/208），其中13例是混合感染腸球菌，208例革蘭陰性菌株培養(yǎng)陽性病例中，男性患兒173例（83.2%），女性患兒35例（16%），性別比例有統(tǒng)計(jì)學(xué)意義（P0.05）。產(chǎn)ESBLS菌株占革蘭氏陰性桿菌感染的10.1%，產(chǎn)ESBLS大腸桿菌占81%，產(chǎn)ESBLS肺炎克雷伯桿菌占19%。所有產(chǎn)ESBLS的菌株對下列抗生素的耐藥率增加，分別是頭孢對噻肟95.2%，頭咆哌酮95.2%，頭孢曲松95.2%，頭孢他啶95.2%和頭孢吡肟100%；對下列抗生素敏感，敏感率分別是美洛西林/舒巴坦95.2%和哌拉西林/舒巴坦95.24%、頭孢西汀90.5%和亞胺培南100%。 結(jié)論：鮑曼不動(dòng)桿菌是大連兒童醫(yī)院急性呼吸道感染最常見的革蘭氏陰性桿菌，大腸桿菌是產(chǎn)ESBL株最多的革蘭氏陰性桿菌。所有的產(chǎn)ESBL的革蘭氏陰性菌對頭孢菌素類藥物（頭孢噻肟、頭咆哌酮、頭孢曲松、頭孢他啶和頭孢吡肟）耐藥，對含有舒巴坦的內(nèi)酰胺類藥物和頭孢西汀和碳青酶烯類藥物敏感，因此,產(chǎn)ESBL株引起的急性呼吸道感染應(yīng)選擇含有舒巴坦的內(nèi)酰胺類藥物、頭孢西汀和碳青酶烯類藥物進(jìn)行治療。
[Abstract]:Objective: to investigate the distribution of Gram-negative bacteria in nasopharynx and to monitor the prevalence and drug sensitivity of Gram-negative bacilli producing ESBL in respiratory ward of Dalian Children's Hospital. To provide the basis for rational use of antibiotics in clinic. Methods: a prospective one year study of 1190 hospitalized patients with respiratory infection from January 2010 to December 2010 was carried out in Dalian Children's Hospital. All the specimens were cultured on chocolate medium and identified by Gram staining and standardised. ESBL producing Gram-negative bacteria were isolated and the antimicrobial sensitivity was determined by K-B method. Results of the 1190 children, 764 were male and 426 were female, 35.80.208 children had Gram-negative bacteria colonized in pharynx, and the positive rate was 17.5% 208 / 1190%. There were 18 strains of Gram-negative bacteria. These include Acinetobacter baumannii 21.2um 44 / 208, Escherichia coli 19.2208m, Klebsiella pneumoniae 12.526 / 208m, Haemophilus influenzae 1225 / 208m, Pseudomonas aeruginosa 11.1cum / 23R / 208G, ESBLS producing strain 10.1 / 21 / 208R, mixed infection 9.62020 / 208N, among them 13 cases were mixed with Enterococcus enterococci positive for Gram negative strains. 173 cases of male and 35 cases of female, the sex ratio is statistically significant (P 0.05). The ESBLS producing strains accounted for 10.1% of Gram-negative bacilli infection, the production of ESBLS Escherichia coli accounted for 81%, and the production of ESBLS Klebsiella pneumoniae accounted for 19.1%. Increased antibiotic resistance, Cefoperazone 95.2%, ceftriaxone 95.2%, ceftazidime 95.2% and cefepime 100 were sensitive to the following antibiotics: meloxicillin / sulbactam 95.2%, piperacillin / sulbactam 95.24, cefoxetine 90.5% and imipenem 100m. Conclusion: Acinetobacter baumannii is the most common Gram-negative bacilli in children's hospital acute respiratory tract infection in Dalian. E. coli is the most gram-negative bacilli producing ESBL strains. All ESBL producing gram-negative bacteria are resistant to cephalosporins (cefotaxime, cephaloperazone, ceftriaxone, ceftazidime and cefepime). Lactams containing sulbactam and cefoxetine and carbenes are sensitive to these drugs. Therefore, lactams containing sulbactam should be selected for acute respiratory infections caused by ESBL strains. Cefoxetine and carbocyanenes were treated.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R766

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本文編號(hào)：1674219