某院4年细菌耐药性监测研究

发布时间：2018-03-08 06:14

本文选题：细菌耐药　切入点：鲍曼不动杆菌　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:统计分析我院2012年至2015年临床分离的细菌分布及G-菌耐药变迁情况,以了解目前细菌耐药情况,指导临床合理选择抗生素。方法:对我院所有临床分离菌采用统一方案进行细菌药敏试验,分别按各年CLSI标准判断结果。结果:1.细菌分布情况我院4年共收集临床分离菌31632株,各年分别占19.2%(6067/31632)、22.9%(7237/31632)、29.8%(9435/31632)、28.1%(8893/31632),其中革兰阳性菌33.2%(10512/31632)株,革兰阴性菌66.8%(21120/31632)。革兰阴性菌中,大肠杆菌占首位,各年分别占25.8%(1017/3941)、24.7%(1186/4803)、26.2%(1663/6355)、29.8%(1792/6021),其次为肺炎克雷伯杆菌,铜绿假单胞菌位于第三。其中鲍曼不动杆菌位于第六。2.细菌的标本分布本研究中,临床分离的菌株主要来源于患者痰液、尿液、血液、分泌液、脓液及其他,分别占52.9%(16736/31632)、8.1%(2566/31632)、3.5%(1109/31632)、11.7%(3691/31632)、7.7%(2426/31632)、16.1%(5104/31632)。其中,痰标本占第一位,其中以肺炎克雷伯杆菌为最常见的细菌,其次是金黄色葡萄球菌;分泌物中常见的细菌为表皮葡萄球菌及大肠埃希菌;尿液中近一半是大肠埃希菌,其次是肠球菌;血液及脓液中主要为大肠埃希菌。3.G-对常见抗生素的耐药性变迁肠杆菌科细菌,对碳青霉烯类、含酶抑制剂的合成抗生素、氨基糖苷类抗生素均保持较高的敏感性,大肠埃希菌对四代头孢的耐药率比三代头孢高,但对四代头孢的敏感性有逐年回升的趋势,对氟喹诺酮类的耐药率分别为42.5%、44.4%、42.9%、40.3%;肺炎克雷伯杆菌对氟喹诺酮类的耐药率较低,对三代、四代头孢耐药率无明显变化趋势;变形杆菌对三代头孢的耐药率各年分别为11.6%、9.1%、8.9%、13.8%;对四代头孢、氟喹诺酮类的耐药率均较高;肠杆菌属对三代、四代头孢、氟喹诺酮类的耐药率均有逐年下降的趋势。在不发酵糖革兰阴性菌中,铜绿假单胞菌对碳青霉烯类、含酶抑制剂的合成抗菌药物、氨基糖苷类的敏感性相对较高,对三代头孢(头孢他啶)的耐药率各年分别为17.9%、10.1%、12.0%、12.4%;对四代头孢(头孢吡肟)的耐药率分别为19.8%、11.3%、10.7%、11.8%;鲍曼不动杆菌对亚胺培南耐药率分别为65.5%、36.4%、59.3%、75.0%,对美罗培南的耐药率分别为83.9%、88.7%、90.4%;对含酶抑制剂合成抗菌素、三代头孢、四代头孢、氨基糖苷类、氟喹诺酮类的耐药率均较高,除对氨基糖苷类的耐药率有逐年下降的趋势外,都呈逐年上升的趋势(P0.05)。结论:我院主要细菌的分布与CHINET显示的结果基本一致,但鲍曼不动杆菌所占比例较国内其他医院低。我院细菌总的耐药情况日渐严重,尤其是鲍曼不动杆菌,对各种抗菌药物的敏感性均差,且耐药率有逐年上升的趋势。部分耐药率高于同期国内水平,故需警惕细菌耐药加重。
[Abstract]:Objective: to analyze the distribution of clinical bacteria isolated from 2012 to 2015 in our hospital and the changes of drug resistance of G- bacteria in order to find out the current situation of bacterial drug resistance. Methods: the antibiotic susceptibility test was carried out on all clinical isolates in our hospital according to the CLSI standard of each year. Results: 1. 31632 strains of clinical isolates were collected in our hospital for 4 years. Each year accounted for 19.267 / 31632 / 22.99.90 / 7237 / 31632 / 29.8and 943535 / 31632 / 28.1and 8893 / 31632 / 8893 / 31632, respectively, among which the gram positive bacteria 33.210512 / 31632, gram negative bacteria 66.8112031632, gram-negative bacteria 66.8112031632.The gram-negative bacteria occupied the first place among the gram-negative bacteria, and each year accounted for 25.8% 10173941% 24.771 886 803% 26.26363 16355P 29.817926021, followed by Klebsiella pneumoniae. Pseudomonas aeruginosa is in third place. Acinetobacter baumannii is located in 6th. 2. The sample distribution of bacteria in this study was mainly from patients' sputum, urine, blood, secretions, pus and others, accounting for 52.9% 16736 / 31632 / 3.51066 / 31632 / 3.51096 / 31632 / 11.3691 / 31632 / 7 / 7 / 7. Klebsiella pneumoniae was the most common bacteria, followed by Staphylococcus aureus; Staphylococcus epidermidis and Escherichia coli were common bacteria in secretions; and Escherichia coli was found in nearly half of the urine. Escherichia coli in blood and pus. 3. 3. G- resistance to common antibiotics Enterobacteriaceae, carbapenems, synthetic antibiotics containing enzyme inhibitors, The resistance rate of Escherichia coli to the fourth generation of cephalosporins was higher than that of the third generation of cephalosporins, but the sensitivity to the fourth generation of cephalosporins increased year by year. The drug resistance rates of Klebsiella pneumoniae to fluoroquinolones were 42.5% and 44.44.49%, respectively, while the resistance rates of Klebsiella pneumoniae to fluoroquinolones were lower than those of the third and fourth generations. The resistance rates of Proteus to the third generation of cephalosporins were 11.69.1and 8.80.The resistance rates to the fourth generation of cephalosporins and fluoroquinolones were higher, and Enterobacter spp. To the third generation and the fourth generation of cephalosporins, The susceptibility of Pseudomonas aeruginosa to carbapenems, synthetic antimicrobial agents containing enzyme inhibitors and aminoglycosides was relatively high. The drug resistance rates of the third generation of ceftazidime were 17.9 / 10.1 and 12.40, respectively; the resistance rates to the fourth generation of cefepime were 19.8and 11.310.7 / 11.8, respectively; the resistance rates of Acinetobacter baumannii to imipenem were 65.56.46.46.47.45 and 75.0, respectively, and those to meropenem were 75.56.46.4and 59.3mm, respectively. The drug resistance rates of acinetobacter baumannii to imipenem were 75.0, and those to meropenem were 75.0, respectively. 83.9% 88.7 and 90.4%; synthesis of antibiotics against enzyme inhibitors, The resistance rates of the third generation, the fourth generation, the aminoglycosides and fluoroquinolones were all high, except the resistance rate of aminoglycosides decreased year by year. Conclusion: the distribution of main bacteria in our hospital is consistent with the results of CHINET, but the proportion of Acinetobacter baumannii is lower than that in other hospitals in China. Especially Acinetobacter baumannii, the sensitivity to various antimicrobial agents is poor, and the drug resistance rate is rising year by year. Part of the drug resistance rate is higher than the domestic level in the same period, so it is necessary to guard against the aggravation of bacterial drug resistance.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R446.5

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