【摘要】：目的：隨著廣譜擴(kuò)生素的廣泛使用，侵入性操作的增加，免疫機(jī)能低下的人群增多，醫(yī)院感染病的原菌譜也發(fā)生了變化，耐藥的細(xì)菌及真菌分離率也增加，成為醫(yī)院感染的重要病原菌。醫(yī)院感染的后果是不但增加了病人的住院時(shí)間，加重了病情，也增加了病人的經(jīng)濟(jì)負(fù)擔(dān)，對(duì)社會(huì)、醫(yī)院尤其對(duì)患者都產(chǎn)生了不良的影響。所以，研究醫(yī)院感染的病原菌分布特點(diǎn)及年代變遷，對(duì)于預(yù)防和控制醫(yī)院感染，提高病人的生活質(zhì)量，增強(qiáng)病人的身體健康，縮短住院時(shí)間，降低病人的經(jīng)濟(jì)負(fù)擔(dān)都具有非常重要的現(xiàn)實(shí)意義。本次研究的主旨在于研究醫(yī)院感染病原菌分布特點(diǎn)以及耐藥性的變化，為臨床合理使用抗生素，增加臨床醫(yī)師的防范意識(shí)提供參考。 方法：采用回顧性調(diào)查方法，隨機(jī)抽取2006-2010年威海市三家醫(yī)院共1775例醫(yī)院感染患者送檢的各類臨床標(biāo)本1285份，按《全國臨床檢驗(yàn)操作規(guī)程》進(jìn)行接種、分離、培養(yǎng)。細(xì)菌分離培養(yǎng)按照美國臨床實(shí)驗(yàn)室標(biāo)準(zhǔn)委員會(huì)（NCCLS）指導(dǎo)的原則，細(xì)菌培養(yǎng)基是M—H瓊脂培養(yǎng)基，所有菌株利用德靈公司MicroScanauto SCAN4微生物全自動(dòng)分析儀進(jìn)行細(xì)菌鑒定，藥敏試驗(yàn)采用二倍系列稀釋法，結(jié)果判斷根據(jù)NCCLS（2005年版）標(biāo)準(zhǔn)進(jìn)行判斷。真菌送檢標(biāo)本的接種、分離、培養(yǎng)、鑒定和藥敏試驗(yàn)均由微生物室按《全國臨床檢驗(yàn)操作規(guī)程》應(yīng)用珠海黑馬生物工程有限公司生產(chǎn)的Bact-IST微生物分析系統(tǒng)及其配套的鑒定卡、藥敏卡完成。 結(jié)果：1285份標(biāo)本檢出病原菌1145株，陽性檢出率89.11%，其中革蘭陰性菌435株，占38.01%；革蘭陽性菌383株，占33.4%；真菌327株，占28.55%。主要菌株為白色假絲酵母菌（12.14%）、大腸埃希菌（11.10%）、糞腸球菌（12.05%）、銅綠假單胞菌（7.17%）、肺炎克雷伯菌（4.90%）；5年大腸埃希菌的分離率呈遞減趨勢(shì)(2006年13.95%、2007年8.67%、2008年8.81%、2009年12.27%、2010年12.06%)，，銅綠假單胞菌的分離率有逐年增高現(xiàn)象（2006年3.10%、2007年5.10%、2008年6.17%、2009年9.39%、2010年8.89%)；真菌檢出率5年比較平穩(wěn)（2006年23.26%、2007年29.08%、2008年29.52%、2009年29.60%、2010年28.57%），亞胺培南是大腸埃希菌、陰溝腸桿菌、鮑曼不動(dòng)桿菌敏感性最高的抗菌藥物；銅綠假單胞菌對(duì)紅霉素、環(huán)丙沙星、亞胺培南的耐藥率比較低；肺炎克雷伯菌對(duì)亞胺培南、氨芐西林的耐藥率低；糞腸球菌對(duì)氨曲南、氨芐西林的耐藥率較低，葡萄球菌對(duì)環(huán)丙沙星的耐藥率最低。而5-氟胞嘧啶和兩性霉素B是假絲酵母菌敏感性最高的藥物。 結(jié)論：醫(yī)院感染的病原菌大多為條件致病菌，不同年份、不同醫(yī)院臨床感染的病原菌的種類、構(gòu)成有所不同；加強(qiáng)醫(yī)院感染病例的細(xì)菌學(xué)監(jiān)測(cè)和動(dòng)態(tài)分析，結(jié)合藥敏試驗(yàn)結(jié)果，合理選擇抗菌藥物，對(duì)開展感染病學(xué)的研究、制定有效的感染控制措施、杜絕感染暴發(fā)流行具有積極意義。
[Abstract]:Objective: with the widespread use of broad-spectrum probiotics and the increase of invasive manipulation, the number of people with low immune function increased, the bacterial spectrum of nosocomial infection also changed, and the isolation rate of drug-resistant bacteria and fungi also increased. It has become an important pathogen of nosocomial infection. The result of hospital infection is that it not only increases the patient's hospitalization time, but also increases the patient's economic burden. It has a bad influence on the society and the hospital, especially on the patient. Therefore, in order to prevent and control nosocomial infection, improve the quality of life of patients, enhance the health of patients and shorten the length of hospital stay, we should study the distribution characteristics and chronological changes of pathogenic bacteria in hospital infection. It is of great practical significance to reduce the financial burden of patients. The main purpose of this study is to study the distribution characteristics of nosocomial infection pathogens and the change of drug resistance in order to provide reference for the rational use of antibiotics in clinic and the increase of clinicians' awareness of prevention. Methods: 1285 clinical specimens of 1775 patients with nosocomial infection were randomly selected from three hospitals in Weihai City from 2006 to 2010 by retrospective investigation. The samples were inoculated, separated and cultivated according to the National practice of Clinical Inspection. In accordance with the principles of (NCCLS), the bacterial culture medium is Mh Agar medium. All strains are identified by MicroScanauto SCAN4 automatic microbe analyzer of Deling Company, and the bacteria are separated and cultured in accordance with the principles of the American Clinical Laboratory Standards Committee of the United States of America. The drug sensitivity test was performed by double series dilution method. The results were judged according to the NCCLS (2005 edition) standard. Inoculation, isolation, culture of fungi for examination, The identification and drug sensitivity test were carried out by the microbiological laboratory according to the National practice of Clinical Inspection. The Bact-IST microbiological analysis system produced by Zhuhai Black Horse Bioengineering Co., Ltd and its matching identification card and drug sensitive card were used. Results: 1145 strains of pathogenic bacteria were detected in 1285 samples, the positive rate was 89.11%, of which 435strains were Gram-negative bacteria (38.01%), 383 strains (33.4%) were Gram-positive bacteria, 327strains (28.55%) were fungi. The main strains were Candida albicans (12.14%), Escherichia coli (11.10%), Enterococcus faecalis (12.05%), Pseudomonas aeruginosa (7.17%) and Klebsiella pneumoniae (4.90%). (13.95% in 2006, 8.67% in 2007, 8.81% in 2008, 12.27% in 2009 and 12.06% in 2010). The isolation rate of Pseudomonas aeruginosa increased year by year (3.10% in 2006, 5.10% in 2007, 6.17% in 2008, 9.39% in 2009 and 8.89% in 2010). The detection rate of fungi was stable for 5 years (23.26% in 2006, 29.08% in 2007, 29.52% in 2008, 29.60% in 2009 and 28.57% in 2010), and imipenem was Escherichia coli and Enterobacter cloacae. Acinetobacter baumannii and Acinetobacter baumannii were the most sensitive antibiotics. The resistance rate of Pseudomonas aeruginosa to erythromycin, ciprofloxacin and imipenem was lower than that of Klebsiella pneumoniae to imipenem and ampicillin. The resistance rate of Enterococcus faecalis to ampicillin and ampicillin was lower than that of staphylococcus to ciprofloxacin. 5-fluorocytosine and amphotericin B were the most sensitive drugs of Candida spp. Conclusion: most of the pathogens of nosocomial infection are conditional pathogens, and the types and compositions of the pathogens in different years and different hospital clinical infections are different. Strengthening the bacteriological monitoring and dynamic analysis of nosocomial infection cases, combining with the results of drug sensitivity test, reasonably selecting antibacterial drugs are of positive significance for the research of infectious diseases, the formulation of effective infection control measures and the prevention of the outbreak of infection.
【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)】：R446.5;R181.3

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