神经内科住院患者感染肺炎链球菌耐药基因分析

发布时间：2018-08-08 12:09

【摘要】：目的了解神经内科患者医院感染病原菌分布情况,检测肺炎链球菌的耐药基因,为临床合理用药提供依据。方法收集本院神经内科住院患者创口无菌棉拭子及创口周围标本,进行肺炎链球菌的培养、分离及鉴定;采用K-B法分析肺炎链球菌的耐药性;采用PCR扩增法检测肺炎链球菌的耐药基因分布情况。结果共分离病原菌377株,主要感染类型为革兰阳性菌(占63.13%),其次为革兰阴性菌(占36.87%)。在238株革兰阳性菌中,肺炎链球菌、金黄色葡萄球菌、酿脓链球菌、屎肠球菌以及其他革兰阳性菌的分离率分别为23.87%、14.06%、10.08%、6.90%和8.22%;在139株革兰阴性菌中,肺炎克雷伯菌、鲍氏不动杆菌、阴沟肠杆菌、铜绿假单胞菌以及其他革兰阴性菌的分离率分别为11.94%、9.02%、6.10%、2.92%和6.90%;分析90株肺炎链球菌的耐药性,其对红霉素耐药率为100.00%,对青霉素、四环素、左氧氟沙星的耐药率分别为32.22%、74.44%、16.67%,对万古霉素耐药率为0。PCR检测肺炎链球菌耐药基因erm、tetM、mefA、gyrA和pbp2b基因大小分别为616、406、346、382和682bp。各耐药基因的检出率分别为62.86%、71.88%、30.77%、10.88%和28.91%。结论神经内科感染病原菌以革兰阳性菌为主,其中又以肺炎链球菌居多。肺炎链球菌的tetM基因和erm基因的检出率较高,治疗肺炎链球菌感染应首选万古霉素。
[Abstract]:Objective to investigate the distribution of nosocomial infection pathogens in patients with neurology and to detect the drug resistance genes of Streptococcus pneumoniae. Methods collected the sterile cotton swabs of wound and the specimens around the wound from inpatients in neurology department of our hospital for the culture, isolation and identification of Streptococcus pneumoniae, and analyzed the drug resistance of Streptococcus pneumoniae by K-B method. The distribution of drug resistance genes of Streptococcus pneumoniae was detected by PCR amplification. Results 377 strains of pathogenic bacteria were isolated. The main type of infection was Gram-positive bacteria (63.13%), followed by Gram-negative bacteria (36.87%). Of the 238 gram-positive strains, Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes, Enterococcus faecium and other gram-positive bacteria were isolated from 6.90% and 8.22% of the 238 Gram-positive bacteria, respectively. Among 139 Gram-negative bacteria, Klebsiella pneumoniae and Acinetobacter baumannii were isolated. The isolation rates of Enterobacter cloacae, Pseudomonas aeruginosa and other gram-negative bacteria were 11.94 and 6.102%, 2.92% and 6.90%, respectively. The resistance rates of 90 strains of Streptococcus pneumoniae to erythromycin, penicillin and tetracycline were analyzed. The resistance rate of levofloxacin to vancomycin and vancomycin were 32.22 and 74.4416.67, respectively. The resistance rate of vancomycin to vancomycin was 616406346382 and 682bprespectively by 0.PCR to detect the resistant gene ermtetMmefAgyrA and pbp2b of Streptococcus pneumoniae. The detection rate of drug resistance genes was 62.86% and 28.91%, respectively. Conclusion Gram-positive bacteria are the main pathogens of neurology infection, and Streptococcus pneumoniae is the most. The detection rate of tetM gene and erm gene of Streptococcus pneumoniae was high. Vancomycin was the first choice in the treatment of Streptococcus pneumoniae infection.
【作者单位】：唐山市人民医院神经内科;天津医科大学内科学教研室;
【基金】：河北省卫生厅基金项目(No.201204600)
【分类号】：R440

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