宁医大总院急诊脓毒症病原学分析

发布时间：2018-01-15 01:37

本文关键词：宁医大总院急诊脓毒症病原学分析　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对宁医大总院急诊科2014年~2015年收治的脓毒症患者病原学结果进行回顾性分析研究,为脓毒症患者的抗菌药物应用提供依据,提高脓毒症患者经验性抗菌药物治疗的有效性。方法:采集宁医大总院急诊科2014年1月1日~2015年12月31日收治的脓毒症患者的血液、痰液、胸腔积液、腹水、脑脊液等标本,采用法国梅里埃公司生产的VITEK-2compact细菌自动鉴定系统进行细菌鉴定,应用纸片扩散法(Kirby-Bauer)进行体外药敏试验,参照2014~2015年美国临床实验室标准化委员会(CLSI)推荐的指南判断结果,统计软件采用SPSS 17.0。结果:151例患者共获得207株分离菌,其中革兰阴性菌占59.4%(123/207),革兰阳性菌29.0%(60/207),真菌11.6%(24/207)。前五位分离菌依次为大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、金黄色葡萄球菌和屎肠球菌,分别占24.6%、12.6%、9.7%、9.7%、9.2%。大肠埃希菌以院外获得感染菌为主,主要来源于血培养,对亚胺培南100%敏感,院外获得感染大肠埃希菌对除氨苄西林舒巴坦、哌拉西林他唑巴坦、呋喃妥因和亚胺培南外的抗菌素耐药率均较院内获得感染菌高。肺炎克雷伯菌对氨苄西林100%耐药,对哌拉西林、呋喃妥因、氟喹诺酮类抗菌素和第二代头孢菌素外的抗菌药物100%敏感。未检出耐碳青霉烯类肠杆菌科细菌(CRE)。鲍曼不动杆菌及铜绿假单胞菌以院内获得感染菌为主,主要来源于痰标本,鲍曼不动杆菌对大部分抗菌药物耐药率均在80%以上,其中亚胺培南耐药率已达95%,广泛耐药鲍曼不动杆菌(XDRAB)检出率达90%,对多数抗菌药物耐药率仍呈上升趋势。金黄色葡萄球菌对呋喃妥因、利奈唑烷、奎奴普汀、替加环素、替考拉宁和万古霉素100%敏感,对青霉素100%耐药,对多数抗菌药物耐药率呈增长趋势。耐甲氧西林金黄色葡萄球菌(MRSA)检出率为45.0%。屎肠球菌对苯唑西林、复方新诺明、替考拉宁、替加环素和万古霉素100%敏感,未检出耐万古霉素肠球菌(VRE)。24株真菌中以念珠菌为主,占91.7%(22/24),念珠菌对氟胞嘧啶100%敏感,其次为两性霉素和伏立康唑,耐药率为7.1%。结论:我院急诊脓毒症患者分离菌以革兰阴性菌为主,多来源于血标本,肺部感染最多,首位分离菌为大肠埃希菌,未检出CRE,鲍曼不动杆菌和铜绿假单胞菌以院内获得感染菌为主,耐药形势严峻,未检出耐万古霉素革兰阳性球菌,临床需密切监测细菌耐药性并采取多方面措施以减缓耐药性的增长。
[Abstract]:Objective: the pathogen of sepsis patients on Ningxia Medical University general hospital emergency department admitted in 2014 ~2015 findings were retrospectively analyzed, and provide the basis for the application of antibacterial drugs in patients with sepsis, improve the effectiveness of empirical antibiotic therapy in patients with sepsis. Methods: Jining Medical University general hospital emergency department in January 1, 2014 ~2015 year in December 31st from the blood of patients with sepsis, sputum, pleural effusion and ascites, cerebrospinal fluid samples, the bacteria were identified by VITEK-2compact bacteria identification system of France bioMerieux company, using paper disc diffusion method (Kirby-Bauer) in vitro susceptibility test, according to 2014~2015 National Committee for clinical laboratory standards (CLSI) guidelines for judging results the use of statistical software SPSS 17.0. results: 151 patients received a total of 207 strains of bacteria, including gram negative bacteria accounted for 59.4%, gram positive (123/207) Bacteria 29%, fungi (60/207) 11.6% (24/207). The top five pathogens were Escherichia coli, Klebsiella pneumoniae, Acinetobacter Bauman, Staphylococcus aureus and Enterococcus faecium, respectively 24.6%, 12.6%, 9.7%, 9.7%, 9.2%. of Escherichia coli in out of hospital acquired infection bacteria mainly, mainly from the blood culture, 100% sensitive to imipenem, hospital acquired infection of Escherichia coli in addition to ampicillin sulbactam, piperacillin tazobactam, antibiotic resistance of nitrofurantoin and imipenem were the rate of nosocomial infection bacteria. Drug resistance of pneumonia Cray Borrelia bacteria to ampicillin was 100%. To piperacillin, nitrofurantoin, fluoroquinolone antibiotics and second generation cephalosporin antibiotics outside the 100% sensitive. No detection of carbapenem resistant Enterobacteriaceae (CRE). Bauman bacillus and Pseudomonas aeruginosa in nosocomial infection bacteria do not move, mainly from sputum From Bauman Acinetobacter to most antimicrobial resistance rates were above 80%, the imipenem resistance rate has reached 95%, extensive drug resistant Acinetobacter Bauman (XDRAB) the detection rate was 90%, the majority of antibacterial drug resistance rate is still increasing. Staphylococcus aureus to nitrofurantoin, linezolid. Que Manu F Dean, tigecycline, teicoplanin and vancomycin 100% sensitive, 100% resistant to penicillin, for most antibiotics is increasing. Methicillin resistant Staphylococcus aureus (MRSA) detection rate of 45.0%. Enterococcus faecium to oxacillin, cotrimoxazole, teicoplanin, tigecycline and vancomycin. 100% sensitive, no detection of vancomycin resistant enterococci (VRE).24 fungi Candida, Candida albicans accounted for 91.7% (22/24), sensitive to flucytosine and amphotericin 100%, followed by voriconazole, the resistant rate was 7.1%. conclusion: the emergency department of our hospital Patients with sepsis isolates of Gram-negative bacteria, mostly from blood samples, pulmonary infection, first isolated bacteria were Escherichia coli, CRE was not detected, Bauman coli and Pseudomonas aeruginosa in nosocomial infection bacteria resistance does not move, the situation is grim, not detected resistant to vancomycin gram positive cocci, clinical need to closely monitor the bacterial resistance and take various measures to slow the growth of drug resistance.

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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