聊城地区临床分离主要病原菌的分布特征及耐药性

发布时间：2018-06-13 01:46

本文选题：临床 + 病原菌　；参考：《山东大学》2015年硕士论文

【摘要】：研究目的1.研究聊城地区某医院临床分离到的主要病原菌的构成比及分布特征,主要包括性别、年龄、标本种类和科室等方面的分布状况。2.了解产酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌以及耐甲氧西林金黄色葡萄球菌的检出率。3.比较主要的革兰氏阴性杆菌在不同组别的耐药率。4.分析主要病原菌对常用抗菌药物的耐药率。5.分别比较肺炎克雷伯菌和大肠埃希菌产酶(ESBLs)菌株与非产酶(ESBLs)菌株对常用抗菌药物的耐药率。6.比较耐甲氧西林金黄色葡萄球菌(MRSA)与甲氧西林敏感金黄色葡萄球菌(MSSA)的耐药率7.了解主要病原菌对常用抗菌药物耐药率的变迁。研究方法1.标本收集：收集聊城地区某院2011年5月—2014年5月临床送检的各类标本,包括痰、尿、伤口分泌物以及血液等标本中分离的位居前五位的主要病原菌,然后对其进行研究分析,菌株都是选取患者首次分离的菌株。2.实验室检测2.1 菌株鉴定：严格按照《全国临床检验操作规程》进行细菌的分离和鉴定,细菌的鉴定采用法国生物梅里埃公司提供的Vitek2-compact全自动微生物鉴定仪器。标准菌株有：肺炎克雷伯菌ATCC700603、大肠埃希菌ATCC25922、铜绿假单胞菌ATCC27853、金黄色葡萄球菌ATCC25923,标准菌株购买于山东省临床检验中心。2.2药敏试验：2.2.1病原菌对常用抗菌药物的耐药性检测采用Vitek2-compact全自动微生物鉴定系统配套的药敏鉴定卡。2.2.2超广谱p-内酰胺酶(ESBLs)和耐甲氧西林金黄色葡萄球菌(MRSA)的检测依据2010年美国临床实验室标准化研究所(CLSI)的标准进行抗菌药物敏感性判断。3.统计学分析：数据的统计分析采用Whonet5.6和SPSS16.0两种软件,采用卡方检验或fisher确切概率法对不同耐药率进行比较,P0.05认为有统计学意义。研究结果1.聊城地区某院2011年5月-2014年5月临床分离的前五位的主要病原菌共1292株。其中以革兰氏阴性杆菌为主,占86.8%,革兰氏阴性杆菌依次为肺炎克雷伯菌31.1%、大肠埃希菌27.9%、铜绿假单胞菌16.0%和鲍曼不动杆菌11.8%；前五位中唯一的一种革兰氏阳性菌是金黄色葡萄球菌,占13·2%。2.病原菌从年龄和性别分布来看,65岁的老年人占60.1%,男女之比为1.4：1；从标本分布来看,主要以痰液为主,占65.9%,其次是尿液和脓液分别为11.1%、11.3%；从科室分布来看,病原菌在重症监护病房的检出率为39.5%,内科病房与外科病房分别为27.3%和26.1%。3.产ESBLs的肺炎克雷伯菌和大肠埃希菌的菌株检出率分别为39.1%、60.6%,二者三年总体均呈下降趋势。耐甲氧西林金黄色葡萄球菌检出率为42.4%。4.革兰氏阴性杆菌对阿米卡星、亚胺培南和哌拉西林/他唑巴坦的耐药率都20%：而对单环类抗生素氨曲南、青霉素类氨苄西林和第一代头孢唑啉、二代头孢呋辛和三代头孢曲松、头孢他啶的耐药率都大于30%。亚胺培南在所有组别中的耐药率最低,为0-7.5%之间,而氨苄西林在所有组别中的耐药率却是最高的,大约在72.2%-89.6%之间。产ESBLs酶与非产ESBLs酶的菌株比较,除亚胺培南、阿米卡星和复方新诺明外,二者对其它抗菌药物都有显著性差异,具有统计学意义(P0.05)。金黄色葡萄球菌对万古霉素、利奈唑胺和替加环素耐药率为0,,对呋喃妥因的耐药率比较低,仅为0.6%,对其余几种抗菌药物的耐药率大约在30-60%之间。5.肺炎克雷伯菌仅对呋喃妥因、氨苄西林／舒巴坦、头孢呋辛、头孢曲松和头孢他啶三年的耐药率变化有统计学意义(P0.05),大肠埃希菌除对头孢吡肟、头孢呋辛和头孢他啶三种抗菌药物的耐药率变化有统计学意义(P0.05)外,二者对其余的抗菌药物的耐药率变化均无统计学意义(P0.05)。鲍曼不动杆菌对抗菌药物的耐药率变化趋势大多数呈上升的趋势。虽然铜绿假单胞菌对氨苄西林／舒巴坦、呋喃妥因、复方新诺明、头孢曲松、头孢他啶、头孢呋辛的耐药率变化不大,但是耐药率一直呈现很高的状态,而阿米卡星的耐药率变化较大,由16.7%下降到0,较明显(P0.05)。金黄色葡萄球菌三年对替加环素、万古霉素和利奈唑胺的耐药率一直为零,除对复方新诺明的耐药率呈上升的趋势外(P0.05),对其他几种抗菌药物的耐药率呈直线下降,三年比较具差异有统计学意义(P0.05)。研究结论1.聊城地区临床分离的病原菌主要是革兰氏阴性杆菌,其次是革兰氏阳性球菌；位居前五位的分别为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌和鲍曼不动杆菌。2.五种病原菌的分布从患者来看,主要是65岁的老年男性患者;从标本分布来看,主要以痰夜为主,其次是尿液和脓液;从科室分布来看,以重症监护病房为主,其次是内科病房和外科等病房。3.聊城地区大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)的现象仍然很严重,并且耐甲氧西林金黄色葡萄球菌在该地区的存在也应引起足够的重视。4.革兰氏阴性杆菌对碳青霉烯类抗生素亚胺培南、p-内酰胺类／酶抑制剂复合剂哌拉西林／他唑巴坦和阿米卡星耐药率较低,而对单环类抗生素、青霉素类和头孢类一、二、三代的抗生素耐药率比较高；亚胺培南在所有组别中的耐药率最低,而氨苄西林在所有组别中的耐药率却是最高的。产ESBLs菌株的耐药率明显高于非产ESBLs菌株。虽然革兰氏阳性金黄色葡萄球菌没有发现对万古霉素、利奈唑胺和替加环素耐药的菌株,但对其它抗菌药物却呈现不同的耐药性。5.肺炎克雷伯菌和大肠埃希菌的三年的耐药率变化不明显,而鲍曼不动杆菌的耐药率变化总体上呈上升趋势,铜绿假单胞菌的耐药率变化不大,但是一直呈现很高的状态,金黄色葡萄球菌的耐药率变化呈下降的趋势。
[Abstract]:Objective 1. to study the composition and distribution characteristics of the main pathogenic bacteria isolated from a hospital in Liaocheng, including the distribution of sex, age, specimen type and department, and so on. The detection rate of Escherichia coli and Klebsiella pneumoniae and methicillin resistant Staphylococcus aureus in Liaocheng was compared with the detection rate of.3.. The resistance rate of the main gram negative bacilli in different groups.4. analysis of the resistance rate of the main pathogens to common antibiotics.5. compared the resistance rate of Klebsiella pneumoniae and Escherichia coli (ESBLs) and non productive enzyme (ESBLs) to common antimicrobial agents compared with.6., methicillin resistant Staphylococcus aureus (MRSA) and a The resistance rate of oxicillin sensitive Staphylococcus aureus (MSSA) 7. to understand the changes in the rate of resistance of the main pathogens to common antibiotics. Methods 1. specimens were collected: collection of specimens from a hospital in Liaocheng from May 2011 to May 2014, including the top five of the specimens, including sputum, urine, wound secretions, and blood. The main pathogenic bacteria were studied and analyzed. The strains were identified by the strain.2. laboratory test for the first time isolated by the patient: strictly according to the national clinical inspection procedure for bacterial isolation and identification, and the identification of the bacteria was used by the Vitek2-compact fully automatic microorganism provided by the French biological merier company. Identification instruments. The standard strains are: Klebsiella pneumoniae ATCC700603, Escherichia coli ATCC25922, Pseudomonas aeruginosa ATCC27853, Staphylococcus aureus ATCC25923, the standard strain purchased in Shandong clinical laboratory center.2.2 drug sensitivity test: 2.2.1 pathogenic bacteria on common antibacterial drug resistance detection using Vitek2-compact fully automatic Microbiology The detection of.2.2.2 hyper broad-spectrum p- lactamase (ESBLs) and methicillin resistant Staphylococcus aureus (MRSA) based on the identification system of physical identification system is based on the criteria of the American clinical laboratory standardization institute (CLSI) in 2010 to conduct a.3. statistical analysis of antimicrobial susceptibility: the statistical analysis of the data uses Whonet5.6 and SPSS16.0. Two kinds of software, using the chi square test or the Fisher exact probability method to compare the different drug resistance rates, P0.05 believed that there were statistical significance. 1. the main pathogens of the first five clinical isolates in a hospital in Liaocheng in May 2011, May, were mainly Gram-negative bacteria, 86.8%, and gram-negative bacilli. Klebsiella pneumoniae 31.1%, Escherichia coli 27.9%, Pseudomonas aeruginosa 16% and Acinetobacter Bauman 11.8%; the only one of the first five Gram-positive bacteria is Staphylococcus aureus, accounting for 13. 2%.2. pathogens from age and sex distribution, 65 years old people account for 60.1%, and the ratio of men and women is 1.4:1; from specimen distribution, the host In the case of sputum, 65.9%, followed by urine and pus were 11.1%, 11.3%, respectively. The detection rate of pathogenic bacteria in intensive care unit was 39.5%, and the detection rates of Klebsiella pneumoniae and Escherichia coli in medical wards and surgical wards of 27.3% and 26.1%.3. respectively were 39.1%, 60.6% and two, respectively, three years, respectively. The overall detection rate of methicillin resistant Staphylococcus aureus was 20% of 42.4%.4. gram-negative bacilli against Amikacin, imipenem and piperacillin / tazobactam, while mono antibiotics amamethanone, penicillin ampicillin and first generation cefazolin, two generation cefuroxime and three generation cephalosporin. The drug resistance rate of ceftazidime was greater than that of 30%. imipenem in all groups, with the lowest resistance rate in all groups, between 0-7.5%, and ampicillin in all groups was the highest, about 72.2%-89.6%. Compared with the strains of ESBLs and non producing ESBLs enzymes, the two groups were compared with amipenem, Amikacin and compound sulfamethoxamine. There were significant differences in other antimicrobial agents (P0.05). The resistance rate of Staphylococcus aureus to vancomycin, linezolid and tenacycline was 0, and the resistance rate to furacytine was low, only 0.6%. The resistance rate of the other kinds of antibiotics was about 30-60% between.5. pneumonia and carbofurein and ammonia only. The resistance rates of benzicillin / Shubatan, cefuroxime, ceftriaxone and ceftazidime for three years were statistically significant (P0.05). The resistance rates of Escherichia coli to cefepime, cefuroxime and ceftazidime were statistically significant (P0.05), and the changes in the rate of resistance to the remaining antibiotics were not statistically significant (P0.05). Learning significance (P0.05). The trend of the change in the resistance rate of Acinetobacter Bauman to antibiotics was most rising. Although Pseudomonas aeruginosa had little change in the rate of ampicillin / Shubatan, furadetin, compound Sulfamethoxine, ceftriaxone, ceftazidime and cefuroxime, the rate of drug resistance had been very high, but the rate of drug resistance had been very high, but Amie The resistance rate of card stars changed from 16.7% to 0 (P0.05). The resistance rate of Staphylococcus aureus to tetracycline, vancomycin and linezolid remained zero for three years, except for the increasing trend of resistance to compound sulfamethamine (P0.05). The resistance rate to several other kinds of antibiotics decreased in a straight line and was worse in three years. There were statistical significance (P0.05). Conclusion 1. the main pathogens isolated in Liaocheng area were gram-negative bacilli and gram-positive coccus, and the top five were the five pathogens of Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter Bauman.2.. In the case of 65 years old male patients, the main results were sputum night, followed by urine and pus; from the section of the Department, the intensive care unit was mainly in the intensive care unit, and the second was the Escherichia coli and Klebsiella pneumoniae in the.3. Liaocheng area of the internal medicine ward and the surgical ward. The phenomenon of the broad-spectrum beta lactamase (ESBLs) was produced in the medical ward and the surgical ward. Still very serious, and the presence of methicillin resistant Staphylococcus aureus in this area should also cause enough attention to.4. gram-negative bacilli to carbapenem imipenem, p- lactam / enzyme inhibitor complex piperazol / tazobactam and Amikacin resistance rates lower, and mono antibiotics, Penicillium, and Penicillium. The resistance rate of antibiotics and cephalosporins was higher in one, two and three generations; imipenem was the lowest in all groups, but the resistance rate of ampicillin was the highest in all groups. The resistance rate of the ESBLs producing strain was significantly higher than that of the non producing ESBLs strain. However, the resistance rate of Klebsiella pneumoniae and Escherichia coli of.5. was not obvious in three years, but the resistance rate of Acinetobacter Bauman showed a rising trend in general, and the resistance rate of Pseudomonas aeruginosa changed little, but it was always present. In a very high state, the resistance rate of Staphylococcus aureus showed a decreasing trend.
【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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