本文選題：慢性鼻-鼻竇炎　切入點：需氧菌　出處：《皖南醫(yī)學院》2016年碩士論文

【摘要】：目的:通過對慢性鼻-鼻竇炎(chronic rhinosinusitis,CRS)患者的鼻腔細菌培養(yǎng)及藥敏檢測,了解本地區(qū)慢性鼻-鼻竇炎患者鼻腔需氧菌分布及藥物敏感性特點,為本地區(qū)臨床抗菌藥物合理選擇提供依據(jù)。方法:在2010年1月1日至2015年12月31日期間,本地區(qū)慢性鼻-鼻竇炎患者中隨機選取181位患者行鼻腔需氧菌培養(yǎng)及藥物敏感試驗。標本在抗菌藥物使用前采集,常規(guī)消毒鼻前庭及鼻周皮膚,無菌前鼻鏡或鼻內(nèi)鏡輔助下,將無菌采樣拭子置入中鼻道,充分與中鼻道腫脹處黏膜及息肉組織接觸擦拭,旋轉(zhuǎn)拭子,留取黏膿性分泌物,在1小時內(nèi)送臨床檢驗中心,行需氧菌分離培養(yǎng)以及藥物敏感試驗,根據(jù)藥敏報告指導臨床合理使用抗菌藥物。根據(jù)年齡特征將患者分為老年CRS患者組、中青年CRS患者組以及未成年CRS患者組。通過卡方檢驗比較老年CRS組與中青年CRS組需氧菌培養(yǎng)報告陽性率差異。結(jié)果:181例標本中1例標本培養(yǎng)2日未見細菌生長,其余180例(99.4%,180/181)標本可見草綠色鏈球菌、奈瑟菌以及革蘭陽性桿菌生長(根據(jù)臨床上呼吸道微生物檢驗陽性報告標準,這類細菌考慮為正常菌群)。臨床檢驗中心共報告需氧菌18株,11個種類,陽性率為9.9%(18/181)。革蘭陽性需氧菌(Gram positive aerobes)10株(5.5%,10/181),其中最常見的菌株為金黃色葡萄球菌(3.3%,6/181);革蘭陰性需氧菌(Gram negative aerobes)8株(4.4%,8/181),最常見的菌株為產(chǎn)氣腸桿菌(1.7%,3/181),其余菌株均勻分布。老年CRS患者組30例標本,報告陽性率為16.7%(5/30),5株菌株均為革蘭陽性菌,其中3株金黃色葡萄球菌比例最高(60%,3/5),余為肺炎鏈球菌及β-溶血A群鏈球菌各1株;中青年CRS患者組139例標本,報告陽性率為9.4%(13/139),革蘭陽性菌5株,革蘭陰性菌8株,最常見的菌株為金黃色葡萄球菌以及產(chǎn)氣腸桿菌。未成年CRS組標本均見上呼吸道正常微生物,無臨床檢驗中心陽性報告。經(jīng)卡方檢驗,中青年CRS患者組與老年CRS患者組報告陽性率差異無統(tǒng)計學意義(?2=1.387,P=0.239,P0.05)。藥物敏感試驗結(jié)果示中青年CRS患者組存在1株甲氧西林耐藥的表皮葡萄球菌(Methicillin resistant Staphylococcus epidermidis,MRSE)以及1株對第三代頭孢類抗菌素耐藥的革蘭陰性桿菌。2株甲氧西林耐藥的金黃色葡萄球菌(Methicillin resistant Staphylococcus aureus,MRSA)在中青年CRS患者組及老年CRS患者組各分布1株。MRSA在金黃色葡萄球菌中的比例為33.3%(2/6)。3株甲氧西林耐藥的葡萄球菌(Methicillin resistant Staphylococcus,MRS)對左氧氟沙星、達福普汀、利奈唑胺以及萬古霉素均敏感�？傮w上氨芐西林、青霉素以及阿莫西林克拉維酸耐藥廣范。未見萬古霉素、第四代頭孢菌素耐藥情況。結(jié)論:慢性鼻-鼻竇炎患者鼻腔需氧菌群以上呼吸道正常菌群為主,菌種廣泛,金黃色葡萄球菌、產(chǎn)氣腸桿菌最常見,其余菌種均勻分布。藥敏結(jié)果示氨芐西林、青霉素以及阿莫西林克拉維酸耐藥率高,左氧氟沙星抗菌活性好。本地區(qū)少數(shù)慢性鼻-鼻竇炎患者鼻腔存在MRS以及對第三代頭孢菌素耐藥的革蘭陰性桿菌,需加強院感監(jiān)測及防控。
[Abstract]:Objective: through for chronic rhinosinusitis (chronic rhinosinusitis, CRS) bacterial culture and drug sensitivity test in patients with nasal cavity, understand chronic nasal - local sinusitis distribution of aerobic bacteria and drug sensitivity characteristics of nasal cavity, selection of drugs provides a basis for the local antibiotic. Methods: in the period from January 1, 2010 to December 31, 2015, 181 patients the nasal cavity bacteria culture and drug sensitivity test were randomly selected for chronic nasal - local sinusitis patients. Specimens before acquisition of antimicrobial drugs, regular disinfection of nasal vestibule and nasal skin, aseptic before the nose or nasal endoscope, the sterile swab into the middle meatus, full and middle meatus mucosa swelling polyps and contact wipe, rotating swab specimens from sticky purulent secretions, send the clinical inspection center in 1 hours, for aerobic bacteria culture and drug sensitivity test, according to drug sensitivity Report to guide clinical rational use of antibiotics. According to the age characteristics of the patients were divided into elderly CRS patients, CRS patients and young adult patients with CRS group. By chi square test to compare the group of patients with CRS culture positive rate between the report and the young group CRS of aerobic bacteria. Results: 181 cases of the 1 specimens in culture 2, no bacterial growth, the remaining 180 cases (99.4%, 180/181) sample showed that Streptococcus viridans, Neisseria and gram positive bacillus growth (according to the clinical respiratory tract microbial test positive report standard, this type of bacteria is considered as normal flora). The clinical inspection center reported a total of 18 strains of aerobes and 11 species. The positive rate was 9.9% (18/181). Gram positive bacteria (Gram positive aerobes) 10 strains (5.5%, 10/181), one of the most common strains of Staphylococcus aureus (3.3%, 6/181); gram negative aerobic bacteria (Gram negative aerobes) 8 strains (4.4%, 8/181 ), the most common strains of Enterobacter aerogenes (1.7%, 3/181), others were evenly distributed. The elderly patients with CRS group of 30 specimens, the positive rate was 16.7% (5/30) report, 5 strains were gram positive bacteria, 3 strains of Staphylococcus aureus was the highest (60%, 3/5). More than for Streptococcus pneumoniae and beta hemolytic streptococcus A group 1 strain; young CRS patients 139 cases, the positive rate was 9.4% (13/139) report, 5 strains of gram positive bacteria, 8 strains of gram negative bacteria, the most common strains of Staphylococcus aureus and Enterobacter aerogenes minor. CRS groups see the upper respiratory tract of normal bacteria, no positive report of clinical inspection center. The chi square test, no statistically significant difference between the positive rate of CRS in young patients and elderly patients with CRS (2=1.387, P=0.239, report? P0.05). Drug sensitivity test results showed that CRS patients in the young group in 1 strains of methicillin the methicillin-resistant Staphylococcus epidermidis Bacteria (Methicillin resistant Staphylococcus epidermidis, MRSE) and 1 strains of the third generation cephalosporin antibiotic resistant gram negative bacillus.2 strains of methicillin resistant Staphylococcus aureus (Methicillin resistant Staphylococcus aureus, MRSA CRS) in young patients and elderly patients with CRS group distribution of 1 strains of.MRSA in Staphylococcus aureus was 33.3% in the (2/6).3 strains of methicillin resistant Staphylococcus aureus (Methicillin resistant, Staphylococcus, MRS) of levofloxacin, Dafoe, leptin, linezolid and vancomycin were sensitive to ampicillin. On the whole, penicillin and amoxicillin clavulanate. No vancomycin resistant wide, fourth generation cephalosporins. Conclusion: the nasal flora of upper respiratory tract normal flora, bacteria, Staphylococcus aureus, Enterobacter aerogenes The most common, other strains of uniform distribution. The results of drug sensitivity showed ampicillin, penicillin and amoxicillin clavulanic acid resistance rate is high, the antibacterial activity of levofloxacin nasal region. Few patients with chronic rhinosinusitis and MRS to the third generation cephalosporin resistant gram negative bacilli, the need to strengthen the hospital infection monitoring and control.

【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R765.21;R765.41

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