鲍曼不动杆菌临床分布特征及耐药性分析

发布时间：2018-05-02 14:52

本文选题：鲍曼不动杆菌 + 抗菌药物　；参考：《吉林大学》2015年硕士论文

【摘要】：目的了解吉林大学中日联谊医院2011年到2013年临床分离鲍曼不动杆菌的临床分布特征及其对常见抗菌药物的耐药性变化。近年来，随着广谱抗生素、免疫抑制剂的大量使用、侵入性医疗操作的广泛开展等，鲍曼不动杆菌的临床分离率不断增加，且耐药现象日趋严重，世界各地陆续出现了多重耐药甚至泛耐药鲍曼不动杆菌，使得临床抗感染治疗成为棘手难题。随着鲍曼不动杆菌临床分离率及耐药性的不断增加，及时准确的诊断，积极的预防以及有效的抗感染治疗显得尤为重要，因此，对鲍曼不动杆菌进行耐药监测，了解其临床分布特征，对有效治疗该菌引起的感染和有效预防其在医院的播散流行具有重要意义。各地区各医院的气候环境、设备条件、治疗措施等不同，鲍曼不动杆菌的感染情况及耐药性、感染特点等也有所不同，为此，本文采用回顾性分析方法统计分析2011年至2013年我院住院患者送检标本中分离的鲍曼不动杆菌的标本来源、临床分布特征和耐药性变化，为指导临床合理选择使用抗菌药物提供重要依据，并且为有效预防和减少鲍曼不动杆菌引起的院内感染及播散流行提供帮助。方法收集吉林大学中日联谊医院2011年至2013年期间临床各科室送检住院患者的各类标本，严格按照《全国临床检验操作规程》的要求培养分离菌株，所有分离菌株应用MicroScan WalkAway96自动化微生物鉴定仪鉴定到种，同时进行药物敏感性试验。按2013年版美国临床和实验室标准协会（CLSI）标准判读药敏试验结果。使用WHONET5.6软件进行统计分析。结果 1.鲍曼不动杆菌占临床分离革兰氏阴性菌比例 2011年我院临床共分离革兰氏阴性菌2035株，其中鲍曼不动杆菌291株，占14.3%；2012年我院临床共分离革兰氏阴性菌3103株，其中鲍曼不动杆菌424株，占13.7%；2013年我院临床共分离革兰氏阴性菌2995株，其中鲍曼不动杆菌301株，占10.1%。 2.鲍曼不动杆菌的标本构成 2011年至2013年临床分离鲍曼不动杆菌共1016株，其中痰标本分离该菌734株，占总分离率的72.2%；脓汁分泌物分离该菌190株，占总分离率的18.7%；尿标本分离该菌21株，占总分离率的2.1%；血培养标本分离该菌25株，占总分离率的2.5%；其他类型标本分离该菌46株，占总分离率的4.5%。分离出鲍曼不动杆菌的主要标本类型为痰标本，超过50%，其次为脓汁分泌物。 3.鲍曼不动杆菌的临床分布特征我院临床科室中鲍曼不动杆菌分离率最高的为神经外科，神经外科2011年至2013年分离的鲍曼不动杆菌占临床总分离率分别为45.0%、32.3%、32.9%；神经外科分离的鲍曼不动杆菌主要来源于痰标本，所占比例三年均接近90%，且分析结果显示神经外科分离的鲍曼不动杆菌耐药现象更为严重，其他该菌分离率较高的科室还有骨科、呼吸内科、胸外科、ICU病房、心内科、神经内科、肿瘤血液科以及肝胆胰外科等。 4.鲍曼不动杆菌对常用抗菌药物的耐药性变化对2011年至2013年我院临床分离鲍曼不动杆菌的耐药性分析结果显示，头孢哌酮/舒巴坦为该菌耐药率最低的抗菌药物，2013年数据与2012年数据比较显示鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率呈现出增加趋势；对碳青霉烯类药物亚胺培南2011年至2013年耐药率分别为44.4%、48.9%、48.5%，三年耐药率均超过40%；对四环素类药物的耐药率2012年为16.7%，2013年为51%，两年数据比较显示对四环素类药物的耐药率有上升趋势；对氨基糖苷类药物阿米卡星2011年至2103年耐药率分别为61.2%、38.2%、35.7%，三年数据比较显示对阿米卡星的耐药率呈现出下降趋势；对喹诺酮类药物环丙沙星耐药率较高，三年均超过50%，对左旋氧氟沙星的耐药率2011年和2012年在50%左右，2013年耐药率有所下降，为35.4%；对头孢类抗菌药物耐药现象严重，三年均在50%以上，其中对头孢噻肟耐药现象最为严重，三年均超过90%。 5.不同类型标本中鲍曼不动杆菌耐药性差别痰标本中鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率最低，其次为左旋氧氟沙星、亚胺培南。其他类型标本中的鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率亦最低，，且低于痰标本中鲍曼不动杆菌对该抗菌药物的耐药率，其次耐药率较低的是亚胺培南，且明显低于痰标本中鲍曼不动杆菌对该抗菌药的耐药率，对阿米卡星的耐药率要高于痰标本中鲍曼不动杆菌。结论 1.鲍曼不动杆菌占临床分离革兰氏阴性菌比例高。 2.鲍曼不动杆菌检出率最高的标本是痰液，提示鲍曼不动杆菌主要引起呼吸道感染。 3.神经外科为我院临床中鲍曼不动杆菌分离率最高的科室，痰液为神经外科分离的鲍曼不动杆菌的主要标本来源，且神经外科分离的鲍曼不动杆菌耐药现象更为严重，其他该菌分离率较高的科室还有骨科、呼吸内科、胸外科、ICU病房、心内科、神经内科、肿瘤血液科以及肝胆胰外科等。 4.三年数据显示鲍曼不动杆菌耐药率未呈出现明显变化，目前头孢哌酮/舒巴坦和亚胺培南仍为治疗该菌所引起感染较为有效的药物。 5.四种常见类型标本所分离的鲍曼不动杆菌耐药率最低的药物均为头孢哌酮/舒巴坦，其中痰标本中鲍曼不动杆菌对头孢哌酮/舒巴坦的耐药率要高于其他类型标本。痰标本中鲍曼不动杆菌对亚胺培南的耐药率明显高于其他类型标本。
[Abstract]:objective
To understand the clinical distribution of Acinetobacter Bauman from 2011 to 2013 of Jilin University and the clinical distribution of Acinetobacter and the change of resistance to common antibiotics. In recent years, the clinical isolation rate of Acinetobacter Bauman has been increasing with the extensive use of broad-spectrum antibiotics, the extensive use of immunosuppressive agents and the extensive development of invasive medical operation. Multidrug-resistant and drug-resistant Acinetobacter Bauman is becoming more and more serious in the world, which makes the clinical anti infection treatment become a difficult problem. With the clinical isolation rate and increasing drug resistance of Acinetobacter Bauman, the timely and accurate diagnosis, the extreme prevention and effective anti infection treatment are particularly important. It is important, therefore, to monitor the drug resistance of Acinetobacter Bauman, to understand the clinical distribution characteristics, to effectively treat the infection caused by the bacteria and to effectively prevent the spread of the epidemic in the hospital. The climate, the equipment conditions, the treatment measures, and the infection and drug resistance of Acinetobacter Bauman in various regions, and the resistance and resistance of Acinetobacter sp. For this reason, the retrospective analysis method is used to analyze the source of the sample of Acinetobacter Bauman isolated from the hospitalized patients from 2011 to 2013, the clinical distribution characteristics and the change of drug resistance, so as to provide an important basis for guiding the rational use of anti bacteria drugs and for effective prevention and treatment. It can help reduce nosocomial infection and disseminated epidemic caused by Acinetobacter Bauman.
Method
All the specimens of the patients in the clinical departments of Jilin University from 2011 to 2013 were collected, and the isolated strains were trained strictly according to the requirements of the national clinical inspection procedure. All the isolates were identified by MicroScan WalkAway96 automated microbial identification instrument, and the drug sensitivity test was carried out at the same time. According to the 2013 edition of the American clinical and Laboratory Standards Association (CLSI) standard, the results of drug sensitivity test were analyzed. WHONET5.6 software was used for statistical analysis.
Result
1. Acinetobacter Bauman accounted for the proportion of Gram-negative bacteria isolated clinically.
In 2011, 2035 strains of Gram-negative bacteria were isolated from our hospital, of which 291 strains of Acinetobacter Bauman, which accounted for 14.3%, 3103 strains of Gram-negative bacteria were isolated in our hospital in 2012, of which 424 strains of Acinetobacter Bauman accounted for 13.7%; 2995 of Gram-negative bacteria were isolated from our hospital in 2013, of which 301 strains of Acinetobacter Bauman accounted for 10.1%..
2. specimens of Acinetobacter Bauman
From 2011 to 2013, 1016 strains of Acinetobacter Bauman were isolated, of which 734 strains were isolated from sputum specimens, accounting for 72.2% of the total separation rate, 190 strains isolated from the abscess, accounting for 18.7% of the total separation rate; 21 strains of the bacteria were isolated from the urine specimens, accounting for 2.1% of the total separation rate, and 25 strains isolated from the blood culture specimen, accounting for 2.5% of the total separation rate, and other classes. Type specimens isolated from 46 strains of bacteria, accounting for the total isolation rate of 4.5%., the main specimens of Bauman Acinetobacter were sputum specimens, more than 50%, followed by pus secretion.
Clinical distribution characteristics of 3. Acinetobacter Bauman
In the clinical department of our hospital, the highest separation rate of Acinetobacter Bauman was in the Department of neurosurgery. The total clinical isolation rate of Acinetobacter Bauman separated from 2011 to 2013 in the Department of neurosurgery was 45%, 32.3%, 32.9%, respectively. The proportion of Acinetobacter Bauman isolated mainly from sputum specimens, the proportion of which was close to 90%, and the analysis showed God. The drug resistance of Acinetobacter Bauman, which was separated by surgery, was more serious. There were Department of orthopedics, respiratory medicine, Department of thoracic surgery, ICU ward, Department of Neurology, tumor and hepatobiliary and pancreatic surgery.
4. drug resistance of Acinetobacter baumannii to commonly used antibiotics in
The drug resistance analysis of the clinical isolates of Acinetobacter Bauman from 2011 to 2013 showed that Cefoperazone / sulbactam was the lowest antibiotic drug in the bacteria. Compared with 2012 data, the drug resistance rate of Acinetobacter Bauman showed an increasing trend in the drug resistance rate of Cefoperazone / sulbactam, and the carbapenems, Ya Anpei, was compared to the 2012 data. The drug resistance rate of Cefoperazone / sulbactam showed an increasing trend; the drug resistance rate of Cefoperazone / sulbactam was increased in 2013; and the carbapenems, Ya Anpei, was the same. The resistance rates from 2011 to 2013 were 44.4%, 48.9%, 48.5% and three years, respectively, and the resistance rates were all over 40% in three years. The resistance rate to tetracycline was 16.7% in 2012 and 51% in 2013. The two years data showed that the resistance rate of tetracycline drugs increased and the resistance rate of aminoglycoside drugs Amikacin to 2103 was 61.2, respectively. The data of%, 38.2%, 35.7%, and three years showed a decline in the resistance rate of Amikacin, a high drug resistance rate to ciprofloxacin, more than 50% in three, 50% in 2011 and 2012 in Levofloxacin and 35.4% in 2013, and 35.4% for the drug resistance of cephalosporins. All of them were more than 50% in three years. Among them, the drug resistance to cefotaxime was the most serious, and all of them were over 90%. in three.
5. drug resistance of Acinetobacter baumannii in different types of specimens, Bauman
The resistance rate of Acinetobacter Bauman to Cefoperazone / sulbactam was the lowest in sputum specimens, followed by levofloxacin and imipenem. The resistance rate of Acinetobacter Bauman to Cefoperazone / sulbactam was also the lowest in other types of specimens, and was lower than that of Acinetobacter Bauman in sputum specimens. Amipenem was significantly lower than that in sputum specimens, and the resistance rate of Acinetobacter Bauman to the antibacterial drug was higher than that of Bauman's Acinetobacter in sputum specimens.
conclusion
1. Acinetobacter Bauman accounted for a high proportion of clinical isolates of gram negative bacteria.
2. the highest detection rate of Acinetobacter Bauman is sputum, suggesting that Acinetobacter Bauman mainly causes respiratory tract infection.
3. in the Department of Neurosurgery, the isolation rate of Acinetobacter Bauman was the highest in our hospital. The sputum was the main source of the specimen of Acinetobacter Bauman isolated from the Department of Neurosurgery, and the drug resistance of Acinetobacter Bauman was more serious. Department of internal medicine, neurology, tumor department of Hematology, hepatobiliary and pancreatic surgery, etc.
The data of 4. three years showed that the resistance rate of Acinetobacter Bauman did not show significant changes. At present, Cefoperazone / Shubatan and imipenem are still more effective drugs for the infection.
5. the lowest drug resistance rates of Acinetobacter Bauman isolated from four common types were Cefoperazone / sulbactam, and the resistance rate of Acinetobacter Bauman to Cefoperazone / sulbactam in sputum specimens was higher than that of other types. The resistance rate of Acinetobacter Bauman to south of Ya Anpei in sputum specimens was significantly higher than that of other types.

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

【参考文献】