医院MRSA分布及万古霉素、替考拉宁、利奈唑胺对其疗效及安全性评价

发布时间：2018-06-25 11:52

本文选题：耐甲氧西林金黄色葡萄球菌 + 院内感染　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:调查我院MRSA感染的分布情况,评估万古霉素、替考拉宁与利奈唑胺治疗MRSA感染的疗效与安全性。方法:搜集重庆医科大学附属第一医院2013年1月-2016年6月期间上报至院感科的MRSA培养阳性病例,统计其标本类型及来源科室,分析我院院内MRSA感染的分布情况。根据用药的不同将其分为3组,即万古霉素组、替考拉宁组与利奈唑胺组,记录患者治疗前后症状、体征、细菌清除情况及不良反应并进行统计分析,比较三者的疗效及副作用。结果:1)我院3年间从送检标本中共分离出111株MRSA菌株,标本中以痰居多,占72.07%,其次分别为血液(占9.91%),分泌物(占8.11%),穿刺液(占4.50%),脓(占2.70%),静脉导管(占1.80%),尿(占1.00%)。患者男女比例为:1.7:1,50岁以上者占60.67%。各科室中,以神经外科(包含ICU)、神经内科(包含ICU)、外科ICU、呼吸科(包含ICU)及中心ICU为最多。2)共89例病例纳入比较,其中包括万古霉素组43例,替考拉宁组27例,利奈唑胺组19例,三种药物有效率分别为:万古霉素65.12%,替考拉宁66.67%,利奈唑胺68.40%,细菌清除率为万古霉素30.0%,替考拉宁33.3%,利奈唑胺31.6%,三组间比较差异均没有统计学意义(P0.05)。不良反应发生率比较:万古霉素32.6%,替考拉宁18.5%,利奈唑胺21.0%,三组间比较差异无统计学意义(P0.05)。平均治疗时间为:万古霉素组(13.72±9.19)d,替考拉宁组(13.85±10.45)d,利奈唑胺组(13.65±8.32)d,三组间两两比较差异均没有统计学意义(P0.05)。结论:需对重点科室加强监督管理,严格无菌操作,避免交叉感染,合理用药,降低感染风险。万古霉素、替考拉宁与利奈唑胺控制MRSA感染疗效相当,临床选用时可根据患者具体情况决定。
[Abstract]:Objective: To investigate the distribution of MRSA infection in our hospital and evaluate the efficacy and safety of vancomycin, teicoplanin and linezolid in the treatment of MRSA infection. Methods: collect the positive cases of MRSA culture in the hospital of First Affiliated Hospital of Chongqing Medical University during the period of June -2016 January 2013, and to analyze the type of specimen and the Department of origin, and analyze me. The distribution of MRSA infection in hospital was divided into 3 groups according to the different drugs, namely vancomycin group, teicoplanin group and linezolid group. The symptoms, signs, bacterial clearance and adverse reactions were recorded before and after treatment, and the effects and side effects of the three were compared. Results: 1) our hospital was divided from the samples in 3 years. 111 strains of MRSA strains were isolated, 72.07% were sputum, followed by blood (9.91%), secretions (8.11%), puncture fluid (4.50%), pus (2.70%), venous catheter (1.80%), and urine (1%). The proportion of men and women over the age of 1.7:1,50 was in the various departments of 60.67%., with Department of Neurosurgery (including ICU), and Neurology (including ICU). Section ICU, Department of respiration (including ICU) and central ICU were the maximum of.2) in a total of 89 cases, including vancomycin group 43 cases, teicoplanin group 27 cases, linezolid group 19 cases, three kinds of drugs effective respectively: vancomycin 65.12%, teicoplanin 66.67%, linezolid 68.40%, bacterial clearance rate of vancomycin 30%, teicoalin 33.3%, Li teicoplanin 33.3%, There was no statistically significant difference between the 31.6% and three groups of nazolamine (P0.05). The incidence of adverse reactions was compared: vancomycin 32.6%, teicoplanin 18.5%, linezolid 21%, and three groups had no statistically significant difference (P0.05). The average time of treatment was: vancomycin group (13.72 + 9.19) d, teicoplanin group (13.85 + 10.45) d, linezolid group 13. (13.) 65 + 8.32) d, the difference between the three groups was not statistically significant (P0.05). Conclusion: it is necessary to strengthen the supervision and management of the key departments, strictly aseptic operation, avoid cross infection, rational use of drugs and reduce the risk of infection. The curative effect of vancomycin, teicoplanin and linezolid in controlling MRSA infection can be determined according to the specific situation of the patients. Make sure.
【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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