延边大学附属医院三年病原菌流行病学分析

发布时间：2018-05-09 04:30

本文选题：病原菌 + 耐药性　；参考：《延边大学》2017年硕士论文

【摘要】：目的:了解2013年-2015年3年间延边医院患者病原菌的分布及对抗菌药物的耐药情况,为将来控制细菌耐药的进一步加重和制定更合理的抗菌方案提供依据。方法:由我院化验室收集2013-2015年医院临床各科室送检的各类标本进行分离培养。基础数据采用EXCEL整理。统计分析,使用SPSS17.0进行趋势卡方检验,P0.05有统计学意义。结果:1.共检出病原菌5693株,其中革兰阴性菌(gram-negative bacteria G-)4258株,占 74.79%、革兰阳性菌(gram-positive bacteria G+)1399 株,占 24.05%、真菌 66株,占1.16%;三年中一直居于前六位的病原菌为鲍曼不动杆菌(acinetobacter baumannii,Aba)(633 株,11.12%)、大肠埃希菌(E.coli,Eco)(1216 株,21.36%)、铜绿假单胞菌(pseudomonas aeruginsa,Pae)(460 株,8.08%)、阴沟肠杆菌(Enterobacter cloaca,Ecl)(304 株,5.34%)、肺炎克雷伯菌(klebsiella pneumonia,Kpn)(761 株,13.37%)、金黄色葡萄球菌(staphylococcus aureus,Sau)(583 株,10.24%)。3年检出耐甲氧西林金黄色葡萄球菌(Methicillin-resistant Staphylococcus aureu,MRS A)222 株,检出产超广谱 β—内酸胺酶(Extended-spectrum β-lactamasesi,ESBL)的阴沟肠杆菌1株。检出产ESBL的大肠埃希菌314株,产ESBL-kpn 50株。其中Eco、Aba逐年增加,Ecl呈下降趋势,有统计学意义,P0.05。3年耐药性分析显示,Aba对多粘菌素耐药率最低(0.95%-16.15%),其次为庆大霉素和头孢他啶,耐药率分别为21.74%,29.81%,其他的头孢类及碳青霉烯类耐药性均较高,都在40%以上。Sau对阿莫西林/克拉维酸钾,哌拉西林/他唑巴坦耐药率分别为13.96-19.02%,6.3-11.21%,2014年检出1株对利奈唑胺耐药的Sau,2015年发现1株对替考拉宁耐药的菌株。Ecl对阿莫西林/克拉维酸钾,氨苄西林存在较高的耐药性88.949%-94.12%,58.89%-70.59%,对阿米卡星,头孢类耐药率较低,经过趋势卡方检验,耐药性呈降低趋势。Kpn对头孢吡肟、头孢噻肟、哌拉西林/他唑巴坦耐药率分别为11.11-15.12%、16.67-20.31%、6.3-11.21%,且卡方检验呈下降趋势。Pae对阿米卡星、庆大霉素的耐药性为6.88-0.8%、12.5-2.4%,耐药率逐年下降,并且具有统计学意义。Eco对碳青霉烯类的敏感性2015年为100%,对头孢吡肟、哌拉西林、左氧氟沙星的耐药性为 11.52-29.28%、70.28-73.68%、55.64-59.87%,经统计分析,耐药率有增高趋势。结论:1.我院2013-2015年病原菌分布以革兰阴性菌为主,变化趋势跟相关报道相符。耐甲氧西林金黄色葡萄球菌、广谱β-内酰胺酶菌株及耐碳青霉烯类肺炎克雷伯菌检出率较低。2.对我院临床常用的喹诺酮类—左氧氟沙星的耐药率升高的是Aba、Ecl;耐药率下降的是Pae、Kpn;对Eco的耐药情况无明显变化。3.对头孢吡肟耐药率升高的病原菌为Eco、Kpn、Aba;头孢西丁对Ecl的耐药率升高。4.Sau、Aba、Kpn、Pae对亚胺培南的耐药率均高于对美罗培南的耐药率。
[Abstract]:Objective: to investigate the distribution of pathogenic bacteria and drug resistance of patients in Yanbian Hospital from 2013 to 2015 so as to provide a basis for controlling the further aggravation of drug resistance of bacteria and making more rational antimicrobial schemes in the future. Methods: samples collected from clinical departments of our hospital from 2013 to 2015 were isolated and cultured. The basic data is sorted out by EXCEL. Statistical analysis, using SPSS17.0 for trend chi-square test (P0.05) has statistical significance. The result is 1: 1. A total of 5693 strains of pathogenic bacteria were detected, of which 4258 were gram-negative bacteria G-G (74.79), 1399 were gram-positive bacteria G (24.05%), 66 strains were fungi. 1. 16; the top six pathogens for three years were Acinetobacter baumanniiani 633, Escherichia coli E. coliformis, E. coli Ecosiella 1216, Pseudomonas aeruginsaa Pae460, M. aeromonas aeruginsaa Pae460, Enterobacter cloacae Ecllc 304 strain 5.34T, Klebsiella pneumoniae klebsiella pneumoniae, klebsiella pneumoniae, 13.3737 golden yellow, C. aeromonas pseudomonas aeruginsaa Pae460 strain 8.08A, Enterobacter cloacae Ecllentella strain 5.34T, Klebsiella pneumoniae klebsiella pneumoniae 761. A total of 583 strains of Staphylococcus aureus were found to be methicillin-resistant Staphylococcus aureus, and 222 strains of methicillin-resistant Staphylococcus aureus were detected in this year. A strain of Enterobacter cloacae producing Extended-spectrum 尾 -lactamase ESBL was tested. Strains of Escherichia coli producing ESBL and 50 strains of ESBL-kpn were tested. The drug resistance of EcoA to polymyxin was the lowest (0.95-16.15), followed by gentamicin and ceftazidime. The resistance rates of other cephalosporins and carbapenes were higher, and the resistance rates were above 40%. Sau was resistant to amoxicillin / clavulanate potassium. The drug resistance rates of piperacillin / tazobactam were 13.96-19.026.3-11.21 in 2014, and one resistant strain was found to be resistant to alnazolidomide. In 2015, a strain resistant to teicoplanin was found to be resistant to amoxicillin / clavulanate, and ampicillin had a higher resistance to amoxicillin, 88.949-94.121,58.89-70.59m, and to amikacin, it was found that there was a high resistance to amikacin. The resistance rates of cefepime, cefotaxime and piperacillin / tazobactam were 11.11-15.1216.67-20.31 and 6.3-11.21, respectively, and the chi-square test showed a decreasing trend. Pae showed a decreasing trend to amikacin, and the resistance rate of cefepime to cefepime, cefotaxime and piperacillin / tazobactam were 11.11-15.127.20.31 and 6.3-11.21, respectively. The drug resistance of gentamicin was 6.88-0.8cm 12.5-2.4.The resistance rate decreased year by year, and the sensitivity of Eco to carbapenem was 100 in 2015, and to cefepime, piperacillin and levofloxacin was 11.52-29.2870.28-73.6855.64-59.87.The drug resistance was 11.52-29.2870.28-73.6855.64-59.87. The rate of drug resistance is increasing. Conclusion 1. Gram-negative bacteria were the main pathogens in our hospital from 2013 to 2015, and the change trend was consistent with the related reports. The detection rate of methicillin-resistant Staphylococcus aureus, broad-spectrum 尾 -lactamases and carbapene-resistant Klebsiella pneumoniae was lower. The resistant rate of Quinolone-Levofloxacin was higher than that of Paeto Kpn, and the resistance to Eco had no significant change. 3. The resistant rate of cefepime to Ecl was higher than that of cefepime, and the resistant rate of cefoxitin to Ecl was higher than that to imipenem. 4. The resistant rate of cefepime to imipenem was higher than that to meropenem.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R446.5

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