碳青霉烯类耐药肠杆菌科资料循证医学评价
发布时间：2018-07-28 16:28
【摘要】：目的：现使用Meta分析的方法,通过查找收集相关课题的研究文献对我国碳青霉烯类抗菌药物耐药的肠杆菌科细菌(CRE)的耐药机制进行概括统计分析；探讨现有各类CRE检测方法的优缺点及灵敏度和特异度的可靠性；对国内医院外科系统感染现状进行循证医学评价,综合全面的了解我国CRE感染流行及相关疾病的检出控制状况。方法：计算机检索PubMed、wanFang Data、VIP、CNKI、The cochrane Library、 EMbase及CBM数据库,将检索时限定为从1994年开始至2014年12月为止,筛选后进行统计及Meta分析。结果：共纳入对CRE耐药机制研究相关文献37篇,共研究分析了我国各地区14个省累积为1081株CRE菌株。显示：菌种前三位是肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌；比较淮河以南和淮河以北的CRE的相关耐药基因显示：目前在我国出现的CRE菌株主要为产生碳青霉烯酶,以KPC酶为首；其次是外膜蛋白的数量减少或缺失伴由染色体或质粒介导持续产生高水平β-内酰胺酶。对有关CRE诊断方法研究,最终纳入文献16篇(中文10篇,英文6篇)。分析显示：(1)改良Hodge试验作为检测CRE菌株的初步筛选试验。(2)CHROMagarTM KPC检测培养皿法：合并特异度及敏感度均不高,但最大的优点为检测方法简便。(3)美罗培南和APBA(3-氨基苯硼酸)联合KPC表型检测：该法操作简单,并提供了客观的判断标准,结果清晰易读,且经现有研究表明其检测KPC的灵敏度与特异度均为10096。国内综合医院感染现状研究的相关文献共纳入87篇。统计分析：综合医院院内感染占内外科室病患的百分比发现,外科体系感染患病机率稍高；月份以9-11月期间医院感染率较高；感染部位以呼吸道、泌尿道、血液为三大易感部位；医院感染检出致病菌种类及构成显示,G-杆菌仍占检出菌一半以上；真菌感染比率有逐年上升趋势。
[Abstract]:Objective: to analyze the drug resistance mechanism of Enterobacteriaceae bacteria (CRE) which is resistant to carbapenems by using the method of Meta analysis. To investigate the advantages and disadvantages, sensitivity and specificity of the existing CRE detection methods, to evaluate the present situation of hospital surgical system infection in China by evidence-based medicine, and to comprehensively understand the detection and control of CRE infection and related diseases in China. Methods: the cochrane Library, EMbase and CBM databases of PubMedwan Fang data VIPI were searched by computer. The search time was limited from 1994 to December 2014. After screening, the data were statistically analyzed and analyzed by Meta. Results: a total of 37 articles on the mechanism of drug resistance of CRE were included. The cumulative number of CRE strains in 14 provinces of China was 1081. The results showed that the first three strains were Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae. The second was the decrease or deletion of outer membrane protein and the continuous production of high level 尾 -lactamases mediated by chromosomes or plasmids. 16 articles (10 in Chinese and 6 in English) were included in the study on the diagnostic methods of CRE. The results showed that: (1) the modified Hodge test was used as a preliminary screening test for the detection of CRE strains. (2) CHROMagarTM KPC assay for petri dishes: the combined specificity and sensitivity were not high. But the biggest advantage is that the detection method is simple. (3) meropenem and APBA (3-aminophenoboric acid) combined with KPC phenotype detection: this method is simple to operate and provides an objective judgment standard, the results are clear and easy to read. The sensitivity and specificity of KPC were 100 96. A total of 87 articles were included in the study on the current situation of general hospital infection in China. Statistical analysis: the percentage of nosocomial infection in general hospital patients in internal and external departments showed that the incidence of infection in surgical system was slightly higher; the nosocomial infection rate was higher between September and November; the infection site was respiratory tract, urinary tract, respiratory tract and urinary tract. The blood was the three most susceptible sites, the species and composition of pathogenic bacteria detected in hospital infection showed that G- bacillus still accounted for more than half of the detected bacteria, and the rate of fungal infection was increasing year by year.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5
本文编号：2150882
[Abstract]:Objective: to analyze the drug resistance mechanism of Enterobacteriaceae bacteria (CRE) which is resistant to carbapenems by using the method of Meta analysis. To investigate the advantages and disadvantages, sensitivity and specificity of the existing CRE detection methods, to evaluate the present situation of hospital surgical system infection in China by evidence-based medicine, and to comprehensively understand the detection and control of CRE infection and related diseases in China. Methods: the cochrane Library, EMbase and CBM databases of PubMedwan Fang data VIPI were searched by computer. The search time was limited from 1994 to December 2014. After screening, the data were statistically analyzed and analyzed by Meta. Results: a total of 37 articles on the mechanism of drug resistance of CRE were included. The cumulative number of CRE strains in 14 provinces of China was 1081. The results showed that the first three strains were Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae. The second was the decrease or deletion of outer membrane protein and the continuous production of high level 尾 -lactamases mediated by chromosomes or plasmids. 16 articles (10 in Chinese and 6 in English) were included in the study on the diagnostic methods of CRE. The results showed that: (1) the modified Hodge test was used as a preliminary screening test for the detection of CRE strains. (2) CHROMagarTM KPC assay for petri dishes: the combined specificity and sensitivity were not high. But the biggest advantage is that the detection method is simple. (3) meropenem and APBA (3-aminophenoboric acid) combined with KPC phenotype detection: this method is simple to operate and provides an objective judgment standard, the results are clear and easy to read. The sensitivity and specificity of KPC were 100 96. A total of 87 articles were included in the study on the current situation of general hospital infection in China. Statistical analysis: the percentage of nosocomial infection in general hospital patients in internal and external departments showed that the incidence of infection in surgical system was slightly higher; the nosocomial infection rate was higher between September and November; the infection site was respiratory tract, urinary tract, respiratory tract and urinary tract. The blood was the three most susceptible sites, the species and composition of pathogenic bacteria detected in hospital infection showed that G- bacillus still accounted for more than half of the detected bacteria, and the rate of fungal infection was increasing year by year.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5
【参考文献】
相关期刊论文 前1条
1 吴敏;周霓;郑仰纯;;患者医院感染相关因素分析及控制措施探讨[J];热带医学杂志;2006年07期
，本文编号：2150882
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