血流感染播散源头及病原学分析

发布时间：2018-04-24 02:44

本文选题：血流感染 + 播散源头　；参考：《华北理工大学》2017年硕士论文

【摘要】：目的通过对713例血流感染病原菌侵袭性及病原学感染特点进行分析,寻找血流感染病原菌的侵袭途径,查找播散源头,切断感染源,以减少血流感染发生率,降低患者死亡率。同时对血流感染病原菌的菌群分布,耐药特点,耐药表型进行分析,指导临床合理用药,减少耐药菌的产生,为临床对血流感染的防控及治疗提供依据。方法每日及时收集华北理工大学附属医院2015年1月到2016年12月血培养阳性病原菌,用Phoenix100全自动细菌鉴定/药敏系统对其做出准确的分离鉴定及药敏试验。同时及时了解患者病情,查找病原菌侵袭性特点、临床耐药性特点、病原菌构成特点,并进一步分析病原菌及科室分布,结合相关实验室检查和病原菌侵袭特点,查找病原菌感染源头。同一时间段内感染灶培养菌株与血培养检出的菌株相同,且除外其他感染来源,认为该感染灶为血流感染的播散源头。结果1血流感染病原菌播散源头情况:两年间共检出713株血流感染病原菌,分离率位于前五的病原菌依次为大肠埃希菌(17.8%)、肺炎克雷伯菌(16.3%)、凝固酶阴性葡萄球菌(10.9%)、鲍曼不动杆菌(7.9%)和金黄色葡萄球菌(7.7%)。静脉导管来源的检出病原菌257株(36.0%),其中226株来自中心静脉导管,以凝固酶阴性葡萄球菌(72株)、鲍曼不动杆菌(55株)为主,主要分布科室为重症医学科和神经外科;泌尿系感染来源146株(20.5%),以大肠埃希菌(70株)为主,主要分布科室为重症医学科、泌尿外科和肾内科;腹腔感染来源114株(16.0%),以肠杆菌科细菌和链球菌为主,主要分布科室为重症医学科和普通外科;下呼吸道感染来源80株(11.2%),以肺炎链球菌(35株)为主,主要分布科室为呼吸内科;外伤感染来源61株(8.6%),以金黄色葡萄球菌(39株)为主,主要分布科室为骨科。其他不明途径55株(7.7%)。2药物敏感情况:常见的革兰阴性菌中,肺炎克雷伯菌和大肠埃希菌对头孢类、喹诺酮类耐药率较高,对碳青霉烯类、氨基糖苷类、酶抑制剂类抗生素较敏感,同时肺炎克雷伯菌的耐药率高于大肠埃希菌,且差异有统计学意义(P0.01)。鲍曼不动杆菌耐药形式严峻,对多种抗生素耐药率均在较高水平。洋葱伯克霍尔德氏菌对头孢他啶、哌拉西林/他唑巴坦、复方新诺明、头孢吡肟较敏感。铜绿假单胞菌对一、二代头孢、复方新诺明天然耐药,对头孢他啶、哌拉西林/他唑巴坦、氨基糖苷类等抗生素敏感。常见的革兰阳性菌中金黄葡萄球菌对青霉素耐药率高达96.5%,肠球菌属对青霉素、氨苄西林较敏感。四种常见阳性菌对利奈唑胺、万古霉素、替考拉宁等均敏感。713例血流感染病原菌中检出多重耐药菌97例,检出率为13.6%。其中产碳青霉烯酶的肠杆菌科细菌47株(48.5%),多重耐药的鲍曼不动杆菌37株(38.1%),耐甲氧西林金黄色葡萄球菌10株(10.3%),多重耐药的铜绿假单胞菌3株(3.1%)。检出科室主要是重症医学科、神经内科重症和神经外科。无论是革兰氏阳性球菌还是革兰氏阴性杆菌,尿中病原菌耐药率稍高于血中的,差异无统计学意义(P0.05)。痰标本里的病原菌耐药率明显高于尿标本和血液标本的耐药率,差异有统计学意义(P0.05)。结论1血流感染病原菌检出率位于前五位的依次为大肠埃希菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌、鲍曼不动杆菌和金黄色葡萄球菌。2病原菌的感染途径静脉导管来源的检出最多,检出菌以凝固酶阴性葡萄球菌、鲍曼不动杆菌占优势,主要分布科室为重症医学科和神经外科;泌尿系感染来源的以大肠埃希菌为主,主要分布科室为重症医学科、泌尿外科和肾内科;腹腔感染来源以肠杆菌科细菌和链球菌为主,主要分布科室为重症医学科和普通外科;下呼吸道感染来源以肺炎链球菌为主,主要分布科室为呼吸内科;外伤感染来源以金黄色葡萄球菌为主,主要分布科室为骨科。3无论是革兰氏阳性菌还是革兰氏阴性菌,尿中病原菌耐药率稍高于血中的,差异无统计学意义;痰标本里的病原菌耐药率明显高于尿标本和血液标本的耐药率,差异有统计学意义。菌血症的控制应结合感染来源,注重查找播散源头,积极治疗感染灶,控制并减少血流感染的发生。
[Abstract]:Objective to analyze the invasiveness and pathogenic characteristics of the pathogenic bacteria in 713 cases of blood infection, search for the invasion pathway of the pathogenic bacteria of the blood flow infection, find the source of the spread of the infection, cut off the source of infection, reduce the incidence of blood flow infection and reduce the mortality of the patients. Analysis, guiding clinical rational drug use, reducing the production of drug-resistant bacteria, providing a basis for clinical prevention and treatment of blood flow infection. Methods the positive pathogenic bacteria in the blood culture of North China University of science and technology from January 2015 to December 2016 were collected in time, and the accurate identification and identification of the pathogenic bacteria were made by Phoenix100 automatic bacterial identification / drug sensitivity system. At the same time, the patient's condition, the characteristics of the pathogenic bacteria, the characteristics of the drug resistance, the characteristics of the pathogenic bacteria, the distribution of the pathogenic bacteria and the Department of the pathogens were further analyzed, and the pathogenic bacteria were found by the related laboratory examination and the characteristics of the pathogenic bacteria. The strains of the infected foci and the blood culture were detected in the same period. The strains were the same, except for other sources of infection. It was believed that the infection was the source of the spread of blood flow infection. Results the source of pathogen spread of the 1 bloodstream infection: 713 pathogens were detected in two years. The first five pathogens were Escherichia coli (17.8%), Klebsiella pneumoniae (16.3%), coagulase negative grapes. Staphylococcus (10.9%), Acinetobacter Bauman (7.9%) and Staphylococcus aureus (7.7%). 257 strains of pathogenic bacteria (36%) were detected from the source of venous catheterization. 226 of them were from central venous catheter, with coagulase negative staphylococcus (72) and Acinetobacter Bauman (55 strains), the main distribution Department was in the severe medicine department and Department of Neurosurgery; the source of urinary tract infection 146 (20.5%), mainly Escherichia coli (70 strains), the main distribution Department was the intensive medicine department, the Department of Urology and the Nephrology; the abdominal infection source was 114 (16%), mainly Enterobacteriaceae and Streptococcus, the main distribution Department was the severe medical department and the general surgery, 80 strains of lower respiratory tract infection (11.2%), and Streptococcus pneumoniae (35 strains). Main distribution Department was respiratory medicine; 61 strains of traumatic infection (8.6%), mainly Staphylococcus aureus (39 strains), the main distribution Department was Department of orthopedics. Other unknown pathways were 55 (7.7%).2 drug sensitivity: common gram-negative bacteria, Klebsiella pneumoniae and Escherichia coli resistance to cephalosporins, quinolones, high rate of quinolones, to carbon green Mycophenolate, aminoglycosides, enzyme inhibitor antibiotics are more sensitive, and the resistance rate of Klebsiella pneumoniae is higher than that of Escherichia coli, and the difference is statistically significant (P0.01). The resistant form of Acinetobacter Bauman is severe and the rate of resistance to a variety of antibiotics is at a high level. Ceftazidime, piperacillin / triazole, Burke and Holder's bacteria Bactam, compound neanolamine, cefepime are more sensitive. Pseudomonas aeruginosa is resistant to first, two generation cephalosporins, compound neoramol, and sensitive to ceftazidime, piperacillin / tazobactam, aminoglycoside. The common gram-positive bacteria are resistant to penicillin by 96.5%, Enterococcus to penicillin, ampicillin Four common positive bacteria were sensitive to linezolid, vancomycin, teicoplanin and other sensitive.713 cases, 97 cases of multidrug resistant bacteria were detected. The detection rate was 47 strains of Enterobacteriaceae (48.5%), 37 strains of Acinetobacter, and methicillin resistant gold yellow grapes, 13.6%.. 10 strains (10.3%) and 3 strains of Pseudomonas aeruginosa resistant to multi drug resistance (3.1%). The detection department is mainly in the severe medicine department, neurology severe and Department of neurosurgery. Whether it is Gram-positive or Gram-negative bacilli, the resistance rate of pathogenic bacteria in urine is slightly higher than that in blood (P0.05). The resistance of pathogenic bacteria in sputum specimens The rate of drug resistance was significantly higher than that of urine samples and blood specimens (P0.05). Conclusion the rate of detection of pathogenic bacteria in the first five places of 1 blood flow infection is in the order of Escherichia coli, Klebsiella pneumoniae, coagulase negative staphylococci, Acinetobacter Bauman and Staphylococcus aureus.2 pathogens. The most detected bacteria were coagulase negative Staphylococcus and Acinetobacter Bauman, the main distribution Department was the intensive medicine department and the Department of Neurosurgery; the main source of urinary infection was Escherichia coli, the main distribution Department was the intensive medicine department, the Department of Urology and the renal internal department; the abdominal infection source was Enterobacteriaceae and streptococcus. The main distribution Department was the intensive medicine department and general surgery. The main source of lower respiratory tract infection was Streptococcus pneumoniae and the main distribution Department was respiratory medicine. The main source of the trauma infection was Staphylococcus aureus. The main distribution Department was the Department of orthopedics.3, gram-positive or Gram-negative bacteria, and the resistance rate of pathogenic bacteria in urine was slight. The difference in resistance rate of pathogenic bacteria in sputum specimens is significantly higher than that of urine samples and blood specimens, the difference is statistically significant. The control of bacteremia should be combined with the source of infection, focus on finding the source of dissemination, actively treat the infection focus, and control and reduce the incidence of blood flow infection.

【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R446.5

【参考文献】