鲍氏不动杆菌血流感染的临床病例特点及有关生物信息学特征的初步分析

发布时间：2019-05-24 21:04

【摘要】：1.血培养中分离到的鲍氏不动杆菌的耐药特征和临床病例特点目的：研究鲍氏不动杆菌血流感染的临床病例特点、耐药特征和病死率及死亡危险因素。对象：病例分析资料是自2006年1月1日至2013年12月31日期间的血培养鲍氏不动杆菌病例,采用医院感染国家卫生部医政司制定的相关规定和美国疾病控制预防中心的血流感染标准确定临床感染病例并去重得到研究病例(211例)。方法：对于病例资料采用描述性的统计方法,应用EXCEL和SAS9.2软件统计相关指标。将病例资料分层分析,分别分为：死亡组和非死亡组,CRAb组和CSAb组,消化道疾病组和非消化道疾病组,监护室组和非监护室组,考察组间在医疗介入措施应用、APACHE-II评分、病死率、科室分布、患者住院时间、BMI指数、主要诊断、抗感染药物和免疫抑制剂应用、感染指标变化、细菌耐药特征方面的统计学差异；应用约登指数、ROC曲线及ROC曲线下面积判断APACHE-II评分对死亡预测的最优指标;应用分类法评估鲍氏不动杆菌血流感染的预后情况。结果：病例中男性患者150人,平均年龄51.39±22.13岁,平均住院时间52.83±71.22天.APACHE-II评分平均值15.D3±9.93分,病死率28.86%,科室分布主要来自外科监护室30%、肝胆外科15%,呼吸科9%和血液科9%,致病菌多为CRAb,对亚胺培南耐药率达到70.8%,对美洛培南耐药率达72.5%。在是否死亡的转归分组中,APACHE-II评分和CRAb感染存在组间差异,APACHE-II评分大于19分的患者是死亡风险较高的人群,在是否CRAb的分组中,应用碳青霉烯药物的人群与不应用此药的人群比较,病死率存在统计学差异；血流鲍氏不动杆菌感染发在消化系疾病诊断的患者占52%,消化系疾病与非消化系疾病患者在应用静脉置管(P=0.02)、手术治疗(P0.0001)、CRRT治疗(P=0.0339)、和其他引流管使用(P=0.0432)上有显著统计差异,消化系统疾病患者在Crab感染率上多于非消化系患者(P=0.0236)。监护室与非监护室比较两组在介入性操作措施、APACHE-II评分(P=0.0039)BMI指数(P=0.0131)间存在统计学差异。应用分类法预测患者转归与实际的符合率在81.5%和76.5%。结论：血培养为鲍氏不动杆菌的病例多出现在一般情况比较差的患者,病死率为28.86%.科室分布排在前三位的是：外科监护室、肝胆外科、呼吸科和血液科,血培养鲍氏不动杆菌的耐药特征为多药耐药和碳青霉烯类耐药。APACHE-II评分大于19分和感染了碳青霉烯类药物耐药的鲍氏不动杆菌是血流感染鲍氏不动杆菌患者的死亡危险因素。应用碳青霉烯类药物可能有助于降低鲍氏不动杆菌血流感染患者的病死率。分类法可以较好的评价鲍氏不动杆菌血流感染患者的预后情况。在血流感染的鲍氏不动杆菌病例中,以消化系统疾病为主要诊断的病例占大多数,他们接受体腔引流管和中心静脉置管的比例要高于非消化系统疾病患者,监护室和肝胆外科是发生耐碳青霉烯药物鲍氏不动血流感染的主要,临床科室。2.血培养中分离到的鲍氏不动杆菌的RNA表达谱的初步研究目的：应用高通量RNA测序技术比较不同来源的鲍氏不动杆菌的基因表达差异,为研究其生物学特征和耐药机制提供依据。对象：测序标本来自2007年鲍氏不动杆菌院内暴发流行时血培养菌株1例、痰培养菌株1例、环境菌株1例及对应病例资料、标准菌株为鲍氏不动ATCC19606。方法：应用高通量RNA测序技术对标本RNA-seq测序并分析结果。结果：血培养鲍氏不动杆菌与痰培养分离的鲍氏不动杆菌在在生物过程中的单一生物体过程和estab l i shment of loca li zation. loca lization. cellular process,存在差异,与标准菌株比OXA-95基因表达出现了上调。结论：在不同生长环境下分离的鲍氏不动杆菌,其基因表达特征存在差异,本研究中血流感染的鲍氏不动杆菌对碳青霉烯类药物耐药的机制可能与OXA-95的表达上调有关。
[Abstract]:1. The characteristics of the drug resistance of Acinetobacter baumannii isolated from blood culture and the characteristics of clinical cases: the clinical characteristics, drug resistance characteristics and mortality and risk factors of the blood flow infection of Acinetobacter baumannii were studied. Object: Case analysis data is a case of Acinetobacter baumannii from 1 January 2006 to 31 December 2013, The clinical infection cases were determined by the relevant provisions of the National Health Department of the Hospital and the blood flow infection standard of the Centers for Disease Control and Prevention in the United States, and the case of the study was re-obtained (211 cases). Methods: Descriptive statistics were used for the case data, and the relevant indexes of EXCEL and S9.2 software were used. The case data were divided into two groups: the death group and the non-death group, the CRAb group and the non-death group, the digestive tract disease group and the non-digestive tract disease group, the intensive care unit group and the non-intensive care unit group, the application of the medical intervention measures among the observation groups, the APACHE-II score, the case fatality rate, the department distribution, the patient's hospital stay time, The index of BMI, the main diagnosis, the anti-infection drug and the application of the immunosuppressive agent, the change of the infection index, the statistical difference of the characteristics of the drug resistance were analyzed, and the optimal index of the APACHE-II score on the prediction of death was determined by using the approximate index, the ROC curve and the area under the ROC curve. The prognosis of the blood flow infection of Acinetobacter baumannii was assessed by using the classification method. Results: The average age was 51.39, 22.13, and the average hospital stay was 52.83-71.22 days. The mean value of APACHE-II was 15.3 and 9.93, the case fatality rate was 28.86%. The distribution of the department was mainly from 30% in the intensive care unit,15% in the liver and the liver,9% in the respiratory and 9% in the family, and the pathogen was CRAB. The resistance rate of the imipenem was 70.8%, and the resistance to meropenem was 72.5%. In the outcome of the death, the APACHE-II score and the CRAb infection were different among the groups, and the patients with the APACHE-II score of greater than 19 were the population with higher risk of death, and in the group of CRAb, the population of the carbapenem drug was compared with those who did not apply the drug, and there was a statistical difference in the case fatality rate; The infection of Acinetobacter baumannii was 52% in the patients with digestive system disease, and the patients with digestive system and non-digestive system were treated with intravenous catheter (P = 0.02), surgical treatment (P = 0.0001), CRRT (P = 0.0339), and other drainage tubes (P = 0.0432). The number of patients with digestive system disease was more than that of non-digestive system (P = 0.0236). There was a statistical difference between the intensive care unit and the non-intensive care unit (P = 0.0039) BMI (P = 0.0131). The coincidence rate between the outcome and the actual coincidence rate of the patients was 81.5% and 76.5%. Conclusion: The case of blood culture for Acinetobacter baumannii is more than that in general condition, and the case fatality rate is 28.86%. The drug resistance of Acinetobacter baumannii was the multi-drug resistance and carbapenem resistance. Acinetobacter baumannii with an APACHE-II score of greater than 19 points and with carbapenem-resistant drug resistance is a risk factor for blood flow infection with Acinetobacter baumannii. The application of carbapenem drugs may contribute to the reduction of mortality in patients with Acinetobacter baumannii. The prognosis of the patients with Acinetobacter baumannii's blood flow infection can be evaluated well. In the case of the blood-flow-infected Acinetobacter baumannii, the majority of cases diagnosed by the digestive system disease as the main diagnosis, and the proportion of the body cavity drainage tube and the central venous catheter is higher than that of the non-digestive system disease patients, The intensive care unit and the hepatobiliary surgery are the main and clinical departments for the occurrence of C. carbapenem. Preliminary study on the RNA expression profile of Acinetobacter baumannii isolated from blood culture: The difference of gene expression of Acinetobacter baumannii from different sources was compared by high-throughput RNA sequencing, and the basis for studying its biological characteristics and drug-resistance mechanism was provided. Object: The sequencing samples were from 1 case of blood culture strain,1 case of sputum culture strain,1 case of environment strain and corresponding case data from the outbreak of Acinetobacter baumannii in 2007, and the standard strain was Acinetobacter baumannii ATCC 19606. Methods: The RNA-seq was sequenced and the results were analyzed by high-throughput RNA sequencing. Results: Acinetobacter baumannii isolated from the culture of Acinetobacter baumannii was isolated from the sputum culture in a single biological process in the biological process and in the test of loca li. Loca lization. There was a difference in the cellular process, and the expression of the standard strain was up-regulated than the expression of the OXA-95 gene. Conclusion: The mechanism of the resistance of Acinetobacter baumannii to carbapenems may be related to the up-regulation of OXA-95 in different growth environments.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R516

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