430株急诊ICU病原菌分布及耐药性回顾性调查

发布时间：2018-01-10 03:33

本文关键词：430株急诊ICU病原菌分布及耐药性回顾性调查　出处：《南昌大学》2015年硕士论文　论文类型：学位论文

更多相关文章： 急诊ICU 细菌分布 耐药性 病原菌

【摘要】：目的:调查南昌大学第一附属医院急诊ICU病房病原菌群分布及其耐药现状,调查急诊ICU病人社区获得性和院内获得性多重耐药菌定植或感染率,为指导临床合理用药和医院内感染控制提供细菌学依据。方法:1、通过回顾性调查方法搜集2013年11月至2015年3月南昌大学第一附属医院急诊ICU住院病人送检标本培养、分离、鉴定和药敏试验结果,分析临床常见病原菌的菌群分布和耐药性,使用Excell和SPSS13.0软件进行统计学分析。2、采用前瞻性设计,收集2014年10月至2015年2月我南昌大学第一附属医院急诊ICU新入院入科时、入科后48小时、7日及出科前的鼻前庭分泌物,做细菌分离鉴定和药敏实验,使用Excell表进行统计学分析。结果:1、2013年11月至2015年3月南昌大学第一附属医院急诊ICU共收治病人690例,采集1052例临床送检标本。2、病原菌主要来源于呼吸道最高,321株(4.66%),其次为血液36株(8.37%)和尿液28株(6.5%),创面分泌物24株(5.58%),其他腹水、胸水、粪便、脑脊液、导管尖端等共占4.88%。3、16个月从临床送检标本中共分离获得430株病原菌,其中355株细菌,75株真菌,分离病原菌阳性率为40.87%。革兰氏阴性杆菌(G-)306株,占总细菌数的86.2%,革兰氏阳性球菌(G+)49株,占总细菌数的13.8%。急诊ICU前六位细菌分别为:鲍曼不动杆菌(29.01%),铜绿假单胞菌(9.58%),大肠埃希氏菌(9.01%),肺炎克雷伯氏菌(8.17%),嗜麦芽黄单胞菌(6.76%),金黄色葡萄球菌(5.63%)。革兰氏阳性菌49株,包括:金黄色葡萄球菌最多(40.8%),其次是屎肠球菌、人葡萄球菌亚种、表皮葡萄球菌、溶血性葡萄球菌、草绿色链球菌。屎肠球菌株明显较粪肠球菌多。真菌共计75株,以白色念珠菌最多。4、耐药性分析:革兰氏阴性菌耐药情况严重,其中鲍曼不动杆菌耐药情况十分严重,大多呈现多重耐药和泛耐药,多耐和泛耐的检出率为61.1%。耐甲氧西林金黄色葡萄球菌的检出率高(60%),替考拉宁药敏未做,利奈唑胺的耐药率为10%,未发现耐万古霉素的金黄色葡萄球菌;未发现对万古霉素、替考拉宁、利奈唑胺耐药的粪肠球菌和屎肠球菌。白色念珠菌对各种抗真菌药物均有较高的敏感性,对氟康唑、伏立康唑、5-氟胞嘧啶、两性霉素-B 90%敏感。5鼻前庭咽拭子培养的结果:入科的120例病人中有59例入科时鼻前庭咽拭子标本中分离出常见的细菌,占病人数的49.2%,其中多重耐药菌占多数。入科48小时后咽拭子标本培养出ICU新的病原菌58株,72小时后培养成70株病原菌,出院前培养出22株病原菌。检出率高的病原菌为金黄色葡萄球菌、大肠埃希氏菌、鲍曼不动杆菌、铜绿假单胞菌、副流感嗜血杆菌、嗜麦芽黄单胞菌等,未见明显定植率特别高的致病菌。结论:1、南昌大学第一附属医院急诊ICU分离的病原菌标本的来源主要以呼吸道和血液、泌尿生殖道为主。病原菌种类多,以革兰氏阴性杆菌为主要病原菌,其中以鲍曼不动杆菌、铜绿假单胞菌、大肠埃希氏菌、肺炎克雷伯氏菌为主,大部分对常用抗菌药物高度耐药和多重耐药性。耐甲氧西林金黄色葡萄球菌检出率高,呈多重耐药。真菌检出率高,以白色念珠菌为主。临床抗感染治疗形势严峻,故临床医师应加强病原学和耐药性监测,根据药敏监测结果合理选用抗菌药物,以提高治愈率。2、南昌大学第一附属医院急诊ICU病人社区获得性MRS菌株比例较高,提示社区获得性-MRS感染者也会逐步增多。我科入院后多重耐药菌定植或感染率高,应当宜加强院感控制和病原学和耐药性监测,减少院内交叉感染。
[Abstract]:Objective: To investigate the First Affiliated Hospital of Nanchang University ICU ward pathogenic bacteria distribution and drug resistance status, investigation of emergency ICU patients with community-acquired and nosocomial multi drug resistant bacteria colonization or infection, provide the bacteriological basis for infection control and guide the clinical rational use of drugs in hospital. Methods: 1, separated by a retrospective survey method to collect the first the Affiliated Hospital of Nanchang University from November 2013 to March 2015 of emergency ICU patients were collected, the culture, identification and drug sensitivity test, analysis of flora distribution and drug resistance of common clinical pathogenic bacteria, were analyzed using.2 Excell and SPSS13.0 software, using a prospective design, collected from October 2014 to February 2015 in the First Affiliated Hospital of Nanchang University, I ICU newly admitted into the hospital emergency department at 48 hours after into the hospital, and 7 days after nasal secretions before, bacterial isolation and drug sensitive test, the Statistical analysis was performed using Excell. Results: 690 cases of emergency ICU were admitted to the First Affiliated Hospital of Nanchang University from November 12013 to March 2015, were collected from 1052 clinical specimens of.2, the main pathogens from respiratory tract, 321 strains (4.66%), followed by blood and urine of 36 strains (8.37%) and 28 strains (6.5%), wound secretion the other 24 strains (5.58%), ascites, pleural effusion, cerebrospinal fluid, feces, catheter tip accounted for 4.88%.3,16 months were isolated 430 strains of pathogenic bacteria from the clinical specimens, including 355 strains of bacteria, 75 strains of fungi, isolation rate of pathogens were gram negative bacillus 40.87%. (G-) 306 strains, total bacteria the number of 86.2%, gram positive cocci and 49 strains (G+), the total number of bacteria 13.8%. emergency ICU top six bacteria were: Bauman Acinetobacter (29.01%), Pseudomonas aeruginosa (9.58%), Escherichia coli (9.01%), Klebsiella pneumoniae (8.17%), from wheat Bud Xanthomonas (6.76%), Staphylococcus aureus (5.63%). 49 strains of gram positive bacteria, including Staphylococcus aureus, most (40.8%) followed by Enterococcus faecium, Staphylococcus species, Staphylococcus epidermidis, Staphylococcus haemolyticus, Streptococcus viridans. Enterococcus strains than Enterococcus faecalis a total of 75 strains of fungi. Candida albicans, most.4, drug resistance analysis of gram negative bacteria resistant in serious condition, in which Bauman Acinetobacter resistance is very serious, mostly showed multiple drug resistance and multidrug resistance and Pan Pan resistant, the detected rate of 61.1%. detection rate of methicillin resistant Staphylococcus aureus (high 60%), teicoplanin susceptibility without resistance to linezolid, the rate was 10%, no vancomycin resistant Staphylococcus aureus to vancomycin, teicoplanin; found that linezolid resistant Enterococcus faecalis and Enterococcus faecium on Candida albicans. The sensitivity of various antifungal drugs had higher to fluconazole, voriconazole, amphotericin 5- and flucytosine, -B 90%.5 sensitive nasal vestibular swab culture results: 120 patients in department in 59 cases of nasal vestibule into the throat swab specimens of isolated bacteria, accounting for 49.2% of the number of patients. The multi drug resistant bacteria accounted for the majority. Cultivate new strains of pathogenic bacteria in the ICU 58 pharyngeal swab specimens into the hospital after 48 hours, 72 hours after cultured 70 strains of pathogenic bacteria, before discharge produced 22 strains of pathogenic bacteria. The detection rate of pathogenic bacteria is high as Staphylococcus aureus, Escherichia coli, Acinetobacter Bauman coli, Pseudomonas aeruginosa, Haemophilus parainfluenzae, Xanthomonas maltophilia, no obvious pathogenic bacteria colonization rate is particularly high. Conclusion: 1, from the First Affiliated Hospital of Nanchang University were isolated pathogens of emergency ICU mainly in the respiratory tract and blood, urinary and reproductive tract for The main pathogenic bacteria species, gram negative bacteria were the main pathogens, which Bauman Acinetobacter, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, most highly resistant to commonly used antibiotics and multi drug resistance. Methicillin resistant Staphylococcus aureus detection rate is high, the multi drug resistance. The high detection rate of fungi, Candida albicans. The clinical anti infection treatment situation is grim, so clinicians should strengthen the monitoring of pathogenic and drug resistance, reasonable use of antibiotics based on the drug susceptibility results, in order to improve the cure rate of.2, the First Affiliated Hospital of Nanchang University of emergency ICU in patients with community-acquired MRS strains will prompt higher proportion gradual increase in community-acquired -MRS infections in our department. After admission of multi drug resistant bacteria colonization or infection rate is high, should strengthen hospital infection control and appropriate pathogen and drug resistance monitoring, reduce hospital cross Infected.

【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5

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