某三级甲等医院多重耐药菌感染现状研究

发布时间：2018-01-11 08:11

本文关键词：某三级甲等医院多重耐药菌感染现状研究　出处：《山东大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究背景中国MRSA(耐甲氧西林金黄色葡萄球菌)监测率达50%,在国际上排名居前；ESBL(产超广谱β内酰胺酶杆菌)、CRE(耐碳青酶烯类肠杆科细菌)、MDRAB (多重耐药鲍曼不动杆菌)等在综合性医院检出比例均较高。MRSA感染几乎遍及全球,成为临床上最常见的病原菌之一,与艾滋病、乙型肝炎一起被称为当今世界三大感染顽疾。各类抗菌药物,尤其是广谱抗菌药物的广泛使用,临床细菌耐药形式严峻,已成为国内外医药界备受关注的问题。为保障医疗安全,同时使医务人员更好的了解多重耐药菌的易感因素和耐药趋势,及早采取合理治疗及防控措施,提高医疗机构诊治水平和防控医院感染,特作以下研究。研究目的1、探讨多重耐药菌易感因素与耐药菌趋势变化情况；2、根据易感因素及多重耐药菌特点,作出多重耐药菌感染的预测；3、分析各种类型多重耐药菌的耐药率,可为临床医生的经验性治疗提供依据；4、根据多重耐药菌检出来源,可采取相关控制措施予以阻断,防止患者的交叉感染；5、通过对多重耐药菌医院感染病例分析,指导临床医务人员开展治疗、护理与防控工作。研究方法回顾性调查2013年-2014年蚌埠市第三人民医院检出的各种多重耐药菌,并对患者的基础资料、标本来源、细菌药敏试验结果等进行统计分析。根据监测结果,作出多重耐药菌的科室分布与耐药趋势变化。通过对患者的基本情况进行卡方检验,评价相关多重耐药菌与年龄、性别、标本来源的关系。分析多重耐药菌的医院感染病例可对医院感染病例进行有针对性的防控。根据相关文献查阅、细菌学特点、科室分布以及相关检验做多重耐药菌的易感因素预测,从而能使临床医生在初诊病人时,可及时考虑多重耐药菌感染的可能性,及早合理选择针对性的抗菌药物治疗。主要结果制定出多重耐药菌科室分布图及耐药趋势变化图。可明显得出多重耐药菌分布以ICU、骨科、普通外科等科室为主,易感因素主要有年龄、侵袭性操作等。MRSA耐药率在40%以上的有红霉素、克林霉素、左氧氟沙星、四环素、利福平、庆大霉素；耐药率在40%以下的有万古霉素、替考拉宁、复方新诺明。在临床治疗怀疑金黄色葡萄球菌感染时应予以参考。ESBL大肠埃希菌耐药率在40%以上的有庆大霉素、复方新诺明、环丙沙星：耐药率在40%以下的有头孢西丁、哌拉西林/他唑巴坦、美罗培南、亚胺培南、阿米卡星；其中,头孢西丁耐药率在30%至40%之间。ESBL大肠埃希菌检出率较高的普通外科等科室,应在使用抗菌药物预防与治疗时予以参考。ESBL肺炎克雷伯菌耐药率与产ESBL大肠埃希菌相比较,对各种抗生素的耐药率略低。产CRE肺炎克雷伯菌临床检出例数增长较快,虽占比不高,但由于可能产KPC酶,针对此类细菌应予以密切关注,防止较多CRE病例出现。MDRAB对临床多种常见抗菌药物耐药率均较高,属泛耐药鲍曼不动杆菌,其在多重耐药菌总量中构成比较高,应引起关注。针对患者入住ICU、年龄、送检标本以及慢性炎症、抗菌药物的选择等均可作为多重耐药菌感染的预测因素及标准。根据不同科室收治患者不同,临床医师可根据相关特点,在患者考虑感染时作出相关预测。作为医院感染管理控制部门,应严控检出较多科室,并加强与微生物实验室联系,提高感染暴发预警意识,同时加强与几个检出较多的临床科室建立重点联系,对该类细菌感染建议联用抗菌药物评价临床效果。结论与建议多重耐药菌检出比例增高明显,各科室均有分布,临床医师可结合患者原发病以及相关易感因素作出多重耐药菌感染的预测,从而能及时合理的选择敏感抗菌药物。多重耐药菌的感染病例较多,不仅局限于医院内,较多慢性炎症患者在长期广泛使用抗菌药物治疗后极易产生细菌耐药,导致多重耐药菌的产生,多重耐药菌的控制应作为一项公共卫生事件来予以干预,纳入相关重点疾病研究,从各个环节控制抗菌药物的滥用,开展医院高发科室的去定植工作,从而有效遏制多重耐药菌的产生。
[Abstract]:On the background of China MRSA (methicillin-resistant Staphylococcus aureus) monitoring rate of 50% in the international ranking; ESBL (ESBLs strains), CRE (carbapenem resistant Enterobacteriaceae), MDRAB (multi drug resistant Acinetobacter Bauman) in general the detection rate of hospital infection of.MRSA were higher in almost all over the world, become one of the most common pathogens in clinical and AIDS, hepatitis B is called the world's three ills. Infection of various antibacterial drugs, especially the widespread use of broad-spectrum antibiotics, clinical bacteria resistant forms of severe, has been paid much attention at home and abroad the medical profession. To ensure medical safety, and medical personnel to better understand the multiple drug-resistant bacteria susceptible factors and the trend of drug resistance, to take reasonable treatment and prevention and control measures as soon as possible, improve the level of diagnosis and treatment of medical institutions and hospital infection prevention and control, especially for The following research. Objective: 1, to investigate multiple drug-resistant bacteria susceptible to changes in trend factors and drug resistant bacteria; 2, and according to the characteristics of multi drug resistant bacteria susceptible factors, make a prediction of multi drug resistant bacteria infection; 3, analysis of drug resistance of multidrug resistant bacteria of various types, can provide the basis for the empirical treatment of clinicians; 4. According to the multi drug resistant bacteria source, can take control measures to block, to prevent cross infection of patients; 5, through the analysis of the cases of multi drug resistant bacteria infection in hospital, clinical medical personnel to carry out the treatment, nursing and Prevention and control work. All kinds of multi drug resistant bacteria research methods retrospective survey in 2013 in Bengbu Third People's Hospital during -2014 detection, and on the basis of data were collected from drug sensitivity test results were analyzed. According to the monitoring results of multi drug resistant bacteria distribution and drug resistance tendency of Department Change. Chi square test was carried out through the basic situation of patients, evaluation of multidrug-resistant bacteria with age, sex, relationship between the specimen source. Analysis of cases of nosocomial infection cases for targeted prevention and control of multidrug-resistant bacteria in hospital. According to the relevant literature, the characteristics of bacteria, distribution of departments and relevant test for multiple drug resistant bacteria susceptible factors, which can make the clinicians in the newly diagnosed patients, may consider the possibility of multi drug resistant bacteria infection in a timely manner, a reasonable choice for early antibiotic treatment. The main results and formulate of multiple drug resistant bacteria distribution and drug resistance of the department changes. The Department of orthopedics may appear out of multidrug resistant bacteria in ICU, general surgery department, the predisposing factors include age, invasive operation.MRSA resistance rate in more than 40% of the erythromycin, clindamycin, tetracycline and levofloxacin, Li Fuping, gentamicin; drug resistance rate of 40% or less are teicoplanin, vancomycin, cotrimoxazole. In the clinical treatment of suspected Staphylococcus aureus infection should be.ESBL reference Escherichia coli resistance rate in more than 40% of the gentamicin, cotrimoxazole, ciprofloxacin resistance rate below 40% of the cefoxitin, piperacillin / tazobactam, imipenem, meropenem, Amikacin; among them, cefoxitin was between 30% and 40%.ESBL of Escherichia coli was higher rate of general surgery department, drug prevention and treatment should be in use to refer to.ESBL Klebsiella pneumoniae compared with the rate of production the ESBL of Escherichia coli, resistant to various antibiotics was slightly low. CRE producing Klebsiella pneumoniae clinical detection the number of cases increased rapidly, although the proportion is not high, but due to the possibility of producing KPC enzyme, the bacteria should be. Cut to prevent more attention, CRE cases of.MDRAB antibiotics were higher in various clinical common genera of Pan drug resistant Acinetobacter Bauman, the multi drug resistant bacteria is higher in total, should be paid more attention. For patients in the ICU age, and the specimens of chronic inflammation, the choice of antibiotics could be used as prediction the factors of multi drug resistant bacteria infection and standard. According to the different departments from patients, clinicians can according to relevant characteristics, make relevant prediction in patients considered infection. As the management of hospital infection control department, should strictly control the detected more departments, and strengthen ties with the microbiology laboratory, improve the outbreak warning consciousness, and strengthen the establishment of key clinical contact the Department with a few more of this type of detection, bacterial infection suggest antibiotic clinical evaluation. The conclusion and suggestion of multiple drug resistant bacteria than Patients increased significantly, each department has distribution, clinicians can patients with primary disease and related risk factors to predict the multi drug resistant bacteria infection combined to timely and reasonable selection of sensitive antibiotics. Multi drug resistant bacteria infections are not only confined to the hospital, many patients with chronic inflammation prone to bacterial resistance in long term the use of antimicrobial drugs after treatment, resulting in multiple drug-resistant bacteria, control of multidrug-resistant bacteria should be used as a public health emergency to be included in the relevant research focus of disease intervention, from all aspects of control system, abuse of antibiotics, hospital departments to work in planting, in order to effectively curb the multidrug-resistant bacteria.

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

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