社区获得血流感染产ESBLs大肠埃希菌及肺炎克雷伯菌流行情况、危险因素及治疗分析

发布时间：2018-05-19 01:00

  本文选题：社区获得 + 血流感染　； 参考：《浙江大学》2015年硕士论文

【摘要】：目的 明确社区发作血流感染ESBLs发生率、危险因素及基因型分布,评价针对产ESBLs细菌感染临床常用抗菌药物疗效。 方法 收集浙江大学附属邵逸夫医院2013年9月11日至2014年11月30日社区获得血培养为大肠埃希菌或肺炎克雷伯菌的病例共54例,测定其中22株产ESBLs菌株对13种抗菌药物的敏感性；通过聚合酶链反应确定产ESBLs菌株基因分布情况,并对患者的临床资料进行分析。 结果 社区获得血流感染大肠埃希菌及肺炎克雷伯菌产ESBLs分别为51.3%,13.3%；年龄为本研究明确的危险因素；22株产ESBLs菌株基因型提示共4株仅产1种β-内酰胺酶,余18株同时携带两种或两种以上基因型。主要基因型为CTX-M-9,其中以CTX-M-14最常见。22株产ESBLs菌株的药敏结果提示碳青霉烯类敏感性高,第三、四代头孢菌素及喹诺酮类耐药率高。临床上不同抗菌药物对产ESBLs菌株感染患者的转归差别明显,其中碳青霉烯类成功率最高,其次为酶抑制剂的复合制剂,其他类抗菌药包括喹诺酮、第三代头孢菌素无成功案例。 结论 社区获得血流感染产ESBLs大肠埃希菌流行情况严峻,年龄是大肠埃希菌和肺炎克雷伯菌产ESBLs的危险因素。碳青霉烯类对产ESBLs的肺炎克雷伯菌和大肠埃希菌具有强大的抗菌活性,其次为p内酰胺酶抑制剂复合制剂,这与临床各类抗菌药物疗效基本相一致。ESBLs基因型主要以cTX-M-14为主,及时监测社区产ESBLs菌的检出率及其耐药情况对指导临床诊疗十分重要。
[Abstract]:Purpose To determine the incidence, risk factors and genotype distribution of ESBLs in community, and to evaluate the efficacy of common antimicrobial agents against ESBLs bacterial infection. Method From September 11, 2013 to November 30, 2014, 54 patients with Escherichia coli or Klebsiella pneumoniae were collected from the hospital of run Shaw, Zhejiang University. The sensitivity of 22 strains producing ESBLs to 13 antimicrobial agents was determined. The gene distribution of ESBLs producing strain was determined by polymerase chain reaction (PCR), and the clinical data of the patients were analyzed. Result The ESBLs produced by Escherichia coli and Klebsiella pneumoniae were 51.3 and 13.3, respectively, and the genotype of 22 strains of ESBLs, which was the risk factor in this study, suggested that 4 strains produced only one 尾 -lactamase. The remaining 18 strains carried two or more genotypes at the same time. The main genotypes were CTX-M-9. The drug sensitivity of 22 strains of ESBLs producing CTX-M-14 showed that carbapenem was highly sensitive and the third and fourth generation cephalosporins and quinolones were highly resistant. The clinical outcome of different antimicrobial agents on ESBLs producing strains was significantly different. The success rate of carbapenem was the highest, followed by the compound preparation of enzyme inhibitors, other antimicrobial agents including quinolone, and the third generation cephalosporins had no successful cases. Conclusion The prevalence of ESBLs producing Escherichia coli in community was severe and age was the risk factor of ESBLs production by Escherichia coli and Klebsiella pneumoniae. Carbapenems have strong antibacterial activity against Klebsiella pneumoniae and Escherichia coli producing ESBLs, followed by p-lactamases inhibitor complex, which is basically consistent with the clinical efficacy of various antimicrobial agents. CTX-M-14 is the main genotype of carbapenem. It is very important to monitor the detection rate and drug resistance of ESBLs producing bacteria in community.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5

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