2004-2006年长春市医院内细菌耐药监测及产超广谱β内酰氨酶基因型特征的研究

发布时间：2018-05-15 18:11

本文选题：细菌耐药 + 革兰阴性杆菌　；参考：《吉林大学》2007年博士论文

【摘要】： 感染性疾病是常见的病种之一,由于抗生素的滥用,细菌的耐药问题日趋严重,因此合理使用抗菌药物,加强抗菌药物的管理,具有长远的社会效益,又有非常重要的经济效益。它是有效控制、减少、延缓病原菌产生耐药的重要措施之一。由于耐药细菌具有随地域分布的特征,不同国家、地区、医院的细菌耐药类型和变迁规律不尽相同,因此,进行区域性细菌耐药监测势在必行,应该成为常规性、周期性开展的基础工作。我国的细菌耐药监测刚刚起步,北京、上海等城市近年在这方面做了一些监测。长春地区尚未见报导。所以进行本市医院内细菌耐药监测及产超广谱β-内酰胺酶基因型分布特征研究,并制定地区细菌耐药谱,对于抗生素合理使用,控制和延缓多重耐药菌产生具有重要的指导意义。本文监测2004-2006年长春市5家三级甲等医院医院感染患者中分离的细菌耐药状况。从2004年1月1日至2006年12月31日分离的3892株病原菌,其中革兰阴性杆菌2660株,革兰阳性球菌1232株,采用K-B纸片琼脂扩散法进行体外敏感试验,并按2002年美国临床实验标准委员会(NCCLS)指导原则的标准计算细菌对抗菌药物的耐药率(R)%、中介率(I)%和敏感率(S)%。监测结果将以耐药监测卡片形式向全市发放。同时采用PCR方法扩增ESBLs基因以确定其基因型。结果发现:1、革兰阳性球菌:未发现对万古霉素、去甲万古霉素耐药或中介金黄色葡萄球菌或凝固酶阴性葡萄球菌菌株。耐甲氧西林凝固酶阴性葡萄球比例有逐年升高趋势。屎肠球菌对胺苄西林耐药率为72.4%,明显高于粪肠球菌对胺苄西林的耐药率37.5%。2、革兰阴性杆菌:占前四位的是大肠埃希菌(43%)、克雷伯菌属(16%)、铜绿假单胞菌(12%)、不动杆菌(10%)。碳青霉烯类是对革兰阴性杆菌(除外嗜麦芽窄食单胞菌)抗菌作用最强的一类抗生素。头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢吡肟和新氟喹诺酮类,如加替沙星、左氧氟沙星对革兰阴性杆菌亦有很好的抗菌活性,但仍有50%-60%的大肠埃希菌对氟喹诺酮类耐药。3、大肠埃希菌和肺炎克雷伯菌产ESBLs检出率为41.2%,ESBLs基因型以CTX-M为主,且耐药率明显高于非产ESBLs大肠埃希菌和肺炎克雷伯菌。本文首次进行长春市医院内细菌耐药监测,按NCCLS指导原则的标准计算细菌对抗菌药物的耐药率(R)%、中介率(I)%和敏感率(S)%,并预期将监测结果以耐药监测卡片形式向全市发放。使临床医师了解本地区医院内感染性疾病病原学药敏情况、病原变迁情况及常见耐药ESBLs基因亚型分子流行病特征,做到合理的经验性使用抗生素,这将对本地区的抗生素合理使用,控制和延缓多重耐药菌产生具有重要的指导意义。
[Abstract]:Infectious disease is one of the common diseases. Because of the abuse of antibiotics, the problem of bacterial drug resistance is becoming more and more serious, so rational use of antimicrobial agents and strengthening the management of antimicrobial agents have long-term social benefits. There are also very important economic benefits. It is one of the important measures to control, reduce and delay the drug resistance of pathogenic bacteria. Because drug resistant bacteria have the characteristics of geographical distribution, the types and changes of drug resistance in different countries, regions and hospitals are different. Therefore, it is imperative to monitor the drug resistance of regional bacteria, which should be routine. Basic work carried out periodically. Surveillance of bacterial resistance has just started in China, and Beijing, Shanghai and other cities have done some monitoring in this area in recent years. Changchun has not been reported yet. Therefore, the surveillance of bacterial drug resistance and the distribution characteristics of extended-spectrum 尾 -lactamases genotypes were carried out in the hospitals of this city, and the bacterial drug resistance profiles were established for the rational use of antibiotics. It is of great significance to control and delay the production of multidrug resistant bacteria. The drug resistance of bacteria isolated from 5 patients with Grade 3A nosocomial infection in Changchun from 2004 to 2006 was monitored. 3892 strains of pathogenic bacteria were isolated from January 1, 2004 to December 31, 2006, of which 2660 were Gram-negative bacilli and 1232 Gram-positive cocci. In vitro sensitivity tests were carried out by K-B disk Agar diffusion method. According to the standard of NCCLS2002, the resistance rate of bacteria to antimicrobial agents was calculated, and the mediating rate and sensitivity rate were calculated. The monitoring results will be issued to the whole city in the form of drug resistance monitoring cards. At the same time, ESBLs gene was amplified by PCR to determine its genotype. The results showed that: 1, Gram-positive cocci: no vancomycin, norvancomycin resistant or intermediate Staphylococcus aureus or coagulase-negative staphylococcus strains were found. The proportion of methicillin-resistant coagulase negative grape balls increased year by year. The resistance rate of Enterococcus faecium to ampicillin was 72.4, which was significantly higher than that of Enterococcus faecalis to ampicillin. Carbapenem is the most potent antibiotic against Gram-negative bacilli (excluding Stenotrophomonas maltophilia). Cefoperazone / sulbactam, piperacillin / tazobactam, cefepime and new fluoroquinolones, such as gatifloxacin, levofloxacin, also have good antibacterial activity against gram-negative bacilli. However, 50% to 60% of Escherichia coli were resistant to fluoroquinolones. The positive rate of ESBLs production of Escherichia coli and Klebsiella pneumoniae was 41.2%. The resistance rate of Escherichia coli and Klebsiella pneumoniae was significantly higher than that of non-producing Escherichia coli and Klebsiella pneumoniae. In this paper, the bacterial drug resistance monitoring in Changchun hospital was carried out for the first time. According to the standard of NCCLS guidelines, the drug resistance rate of bacteria to antimicrobial agents was calculated. The mediating rate and sensitivity rate were calculated, and the results were expected to be issued to the whole city in the form of drug resistance monitoring cards. To make clinicians understand the pathogenic drug sensitivity, pathogen changes and molecular epidemiological characteristics of common drug resistant ESBLs gene subtypes in local hospitals, so as to make rational empirical use of antibiotics. This will be of great significance to the rational use of antibiotics, control and delay the production of multidrug resistant bacteria.
【学位授予单位】：吉林大学
【学位级别】：博士
【学位授予年份】：2007
【分类号】：R446.5;R378

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