急诊内科下呼吸道感染细菌分布及耐药性分析

发布时间：2018-01-15 01:05

本文关键词：急诊内科下呼吸道感染细菌分布及耐药性分析　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:了解辖区或医疗机构内抗菌药物临床应用和细菌耐药情况,定期对抗菌药物临床应用管理和细菌耐药形式进行评价,根据监测情况,逐步建立完善的抗菌药物临床应用机制可以使抗生素的应用更加规范及合理化。所以动态监测我院急诊内科细菌急重症下呼吸道感染患者细菌分布及耐药性的变迁,为初始经验性广谱抗生素的选择提供依据,同时分析细菌及其耐药性变迁的原因,为其多重耐药菌感染的预防提供依据。方法:收集我院急诊内科2014.1—2016.12收治的下呼吸道感染病例,对临床分离病原菌的细菌分布及耐药性进行回顾性分析;结果:共收集下呼吸道感染病例805例,年龄为38岁至95岁之间,60岁以上老年患者占91.62%,共检出细菌及真菌258例,阳性率32.05%。分离出细菌共151例,最常见的细菌为铜绿假单胞菌共39例,鲍曼不动杆菌共28例,肺炎克雷伯菌29例,其他细菌为副流感嗜血杆菌、肺炎链球菌、金黄色葡萄球菌等,共54例;近年来,铜绿假单胞菌所占比例有下降趋势,鲍曼不动杆菌所占比例有明显上升趋势,且多耐药菌比例加重,几乎所有检出的鲍曼不动杆菌均为多耐药菌。3年间肺炎克雷伯菌的检出率无明显差异。铜绿假单胞菌对β-内酰胺酶抑制剂及氨基糖苷类抗生素敏感性高,故建议联合应用,不仅可以缩短疗程,还可以减少药物副作用的发生;铜绿假单胞菌对碳青霉烯类抗生素的耐药性有上升趋势,且频繁使用碳青霉烯类抗生素会诱导多耐药菌株的出现,故建议在治疗上应慎用,同时加强多耐药铜绿假单胞菌菌株的检出,及时作出预防措施。结论:我科细菌耐药性呈逐年上升的趋势,多重耐药菌广泛出现,应根据细菌分布及对药物的敏感性合理选择抗生素,对预防耐药菌的出现具有重要意义。
[Abstract]:Objective: to understand the area or within the medical institutions for clinical application of antibacterials and bacterial resistance to antimicrobial drugs, regular management of clinical application and bacterial resistance forms were evaluated according to the monitoring, and gradually establish and improve the mechanism of clinical application of antibacterial drugs can help the application of antibiotics more standardized and rational. So the change of dynamic monitoring of the emergency internal medicine in our hospital of acute bacterial severe lower respiratory tract infection in patients with bacterial distribution and drug resistance, to provide the basis for the choice of initial empiric broad-spectrum antibiotics, and analysis the reasons for changes in bacteria and drug resistance, provide the basis for the prevention of the multi drug resistant bacteria infection. Methods: collected in our hospital emergency internal medicine 2014.1 - 2016.12 from lower respiratory tract infection, bacterial distribution and drug resistance of clinical isolates the pathogens were retrospectively analyzed; results: collected 805 cases of lower respiratory tract infection, age Between 38 and 95 years old, 60 years old accounted for 91.62% of patients were found in bacteria and fungi in 258 cases, the positive rate of 32.05%. bacteria isolated from a total of 151 cases, the most common bacteria were Pseudomonas aeruginosa in 39 cases, a total of 28 cases of Bauman Acinetobacter, Klebsiella pneumoniae in 29 cases, other bacterial vice Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, a total of 54 cases; in recent years, the proportion of Pseudomonas aeruginosa decreased, Bauman Acinetobacter proportion has increased significantly, and the proportion of multi drug resistant bacteria increased, almost all were Bauman Acinetobacter were during the period of.3 resistant strains of Klebsiella pneumoniae were detected. No significant differences in the rates of Pseudomonas aeruginosa to beta lactamase inhibitors and aminoglycoside antibiotic sensitivity, the combination can not only shorten the course of treatment, can also reduce the adverse reactions; Pseudomonas aeruginosa Bacterial resistance to carbapenems are rising, and the frequent use of carbapenem antibiotics induced by multi drug resistant strains, it is recommended in the treatment should be used with caution, while strengthening the detection of multi drug resistant Pseudomonas aeruginosa strains, timely preventive measures. Conclusion: our department of bacterial resistance increased year by year the trend of multidrug-resistant bacteria is widespread, a reasonable choice of antibiotics should be based on the distribution of bacteria and the drug sensitivity, it is very important for prevention of drug-resistant bacteria.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R56;R446.5

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