浙江省急性腹泻患者气单胞菌的流行与药物敏感性分析

发布时间：2018-01-18 15:10

  本文关键词：浙江省急性腹泻患者气单胞菌的流行与药物敏感性分析　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 腹泻 气单胞菌 流行性 药物敏感性

【摘要】：目的:气单胞菌(Aeromonas)广泛存在于水环境中,是常见的人畜鱼共患病原菌,已有多个国家和地区报道过其较大规模的暴发流行,成为我国水产养殖业发展的主要威胁,还能单独或者混合感染人类,导致人类肠道内外感染,是我国夏季腹泻的常见病原菌之一,严重威胁公众健康。气单胞菌的分布情况和药物敏感特征在世界多个地区均有报道,但本地区的相关报道比较少,本课题通过收集浙江地区急性腹泻患者粪便标本,开展气单胞菌的监测研究,以阐明气单胞菌的流行,为临床上科学开展腹泻致病菌的常规检测提供依据;通过药敏试验,获得浙江省气单胞菌的耐药谱,为气单胞菌感染的防控提供流行病学依据,为临床气单胞菌感染的治疗提供参考,并为耐药机制的研究奠定基础。方法:2010年1月至2015年12月,从我国浙江地区6家哨点医院采集急性腹泻患者的粪便标本,用常规微生物检验程序对常见肠道致病菌进行分离培养,采用德国布鲁克微生物鉴定质谱仪MALDI-TOF Biotyper系统对微生物进行鉴定。对分离鉴定的气单胞菌采用纸片扩散法(K-B法)进行药敏检测及分析,并结合临床资料对气单胞菌进行流行病学分析。结果:1.2010年1月-2015年12月,共收集急性腹泻患者粪便标本8589份,分离到503株气单胞菌,检出率为5.9%,列腹泻患者细菌性病原第三位。503株气单胞菌中豚鼠气单胞菌最多194株(38.6%),其次是维氏气单胞菌142株(28.2%)、嗜水气单胞菌80株(15.9%)、肠棕气单胞菌45株(8.9%)、简氏气单胞菌27株(5.4%)、小鱼气单胞菌14株(2.8%)、异常嗜糖气单胞菌1株(0.2%);2.503例气单胞菌检出率存在男女性别差异(P0.05),女性6.5%,男性5.3%;不同年龄组的检出率存在统计学差异(P0.05),以45-59岁中年人群检出率(7.6%)最高,其次是18-44岁青年人群(6.8%);不同季节检出率差异具有统计学意义(P0.05),以夏季(6-8月)的检出率最高,达10.2%。3.503株气单胞菌对17种纳入研究的抗菌药中的大部分保持着较高的敏感性,对阿米卡星敏感率为94.8%,左氧氟沙星敏感率为93.8%,庆大霉素为92.4%,头孢他啶为92.0%。但对四环素、亚胺培南和头孢西丁的敏感率相对较低为59.0%、59.8%和61.9%,且对亚胺培南和四环素的中度敏感率较高,分别为20.7%和16.1%。4.豚鼠气单胞菌对阿米卡星的敏感率最高,为94.8%,而对头孢呋辛的敏感率较低,为43.0%;维氏气单胞对氨曲南和头孢他啶的敏感率最高,为97.9%,对亚胺培南的敏感率最低,为25.4%,而同为碳青霉烯类的美洛培南则为78.9%;嗜水气单胞菌对阿米卡星、氨曲南敏感率最高,为97.5%,对头孢西丁的敏感率最低,为35.0%;肠棕气单胞菌对头孢他啶、头孢曲松和左氧氟沙星的敏感率达100%,最低的头孢西丁也有60.0%;小鱼气单胞菌对头孢他啶和左氧氟沙星的敏感率为100%,对四环素的敏感率最低,为48.1%;简氏气单胞菌对阿米卡星、哌拉西林/他唑巴坦、庆大霉素、头孢吡肟、头孢噻肟和头孢曲松的敏感率较高,为92.9%,对亚胺培南敏感率最低,为28.6%;所选的17种抗菌药物中只有阿米卡星和哌洛西林\他唑巴坦对各菌种间的敏感性无明显差异(P=0.669,P=0.588),且这两种抗菌药物对各菌种的敏感性都比较高;豚鼠气单胞菌和肠棕气单胞菌对亚胺培南的敏感率(82.0%,73.3%)明显高于其他气单胞菌(P0.05);维氏气单胞菌、嗜水气单胞菌、小鱼气单胞菌和简氏气单胞菌中亚胺培南的敏感性明显低于同为碳青霉烯类药物的美洛培南;维氏气单胞菌和小鱼气单胞菌对头孢西丁的敏感率(83.1%,96.3%)明显高于其他气单胞菌(P0.05);豚鼠气单胞菌和嗜水气单胞菌对17种抗菌药物的敏感性普遍低于维氏气单胞菌、肠棕气单胞菌、小鱼气单胞菌和异常嗜糖气单胞菌(P0.05)。5.503株气单胞菌中有128株(25.4%)气单胞菌混合其他细菌或病毒的感染,其中以豚鼠气单胞菌(36株,28.1%)和维氏气单胞菌(37株,28.9%)为主,但比较容易出现混合感染的菌种是简氏气单胞菌和小鱼气单胞菌,其混合感染率分别是 50.0%和 44.4%。结论:1、浙江省急性腹泻患者中气单胞菌检出率高达5.9%,列腹泻患者细菌性病原第三位,以夏季为主,感染人群以中年为多。2、肠道来源气单胞菌主要为豚鼠气单胞菌、维氏气单胞菌和嗜水气单胞菌。3、肠道气单胞菌对阿米卡星、左氧氟沙星、庆大霉素及头孢他啶敏感性高,对四环素、头孢西丁和亚胺培南敏感性差,不同菌种对抗菌药物的敏感性存在差异。
[Abstract]:Objective: Aeromonas (Aeromonas) widely exist in the water environment, is a common pathogen of human and animal fish, there are a number of countries and regions reported its popular large-scale outbreak, become a major threat to the development of aquaculture in our country, but also alone or mixed infection of humans, leading to infection of human intestinal and that is one of the common pathogenic bacteria of diarrhea in summer in our country, a serious threat to public health. The distribution and drug sensitivity characteristics of Aeromonas were reported in many parts of the world, but relatively few reports in this area, through the collection of stool specimens of patients with acute diarrhea in Zhejiang area, to carry out monitoring of Aeromonas to clarify, Aeromonas epidemic, provide the basis for clinical science to carry out routine detection of pathogenic bacteria of diarrhea; through drug sensitivity test, drug resistance in Zhejiang province Aeromonas spectrum of Aeromonas infection To provide epidemiological evidence for prevention and control, to provide reference for clinical treatment of Aeromonas infection, and study the mechanism of resistance to lay the foundation. Methods: from January 2010 to December 2015, from 6 sentinel hospitals in Zhejiang area of our country stool specimens of patients with acute diarrhea were cultured on the collection of common intestinal pathogens using conventional micro biological test program identification of microorganisms, microbial identification by Germany Brook mass spectrometer MALDI-TOF Biotyper system. The isolation and identification of Aeromonas using disk diffusion method (K-B method) for detection and analysis of drug sensitivity, and combined with the clinical data of Aeromonas were analyzed. Results: 1.2010 years in January -2015 year in December were collected, acute 8589 diarrhea stool specimens were isolated, 503 strains of Aeromonas, the detection rate was 5.9%, among patients with diarrhea bacterial pathogens of third strains of Aeromonas.503 gas in guinea pig Aeromonas 鑿屾渶澶，

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