青岛市儿科住院患者多重耐药菌分布及耐药性分析

发布时间：2018-05-08 13:47

本文选题：儿童 + 多重耐药菌　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:了解青岛某三甲医院住院患儿临床分离的多重耐药菌的分布和变化趋势及对检出的多重耐药菌的耐药性分析,指导临床合理用药。方法:回顾性分析2013-2015年于青岛大学附属医院儿科住院患儿中分离的多重耐药菌,对其分布、耐药性进行统计学分析。结果:青岛某三甲医院2013-2015年共分离出469株致病菌,其中多重耐药菌为357株,革兰氏阳性菌208株,革兰氏阴性菌145株,真菌4株。最多见的多重耐药菌为多重耐药凝固酶阴性葡萄球菌(MRCNS),其次为产ESBLs大肠埃希菌,耐甲氧西林金黄色葡萄球菌(MRSA);自2013-2015年耐甲氧西林金黄色葡萄球菌(MRSA)由3.09%增长至24.73%,产ESBLs大肠埃希菌由6.18%增长至21.50%,HLAR由1.03%增长至6.45%,产ESBLs肺炎雷伯菌、阴沟肠杆菌、鲍氏不动杆菌逐年检出率出现下降趋势;普通儿科检出多重耐药菌占总耐药菌的40.89%,血液儿科为24.64%,新生儿科为34.47%;标本检出率最高为血液(56.58%),其次分别为尿液(14.29%)、痰液(8.96%),其中多重耐药凝固酶阴性葡萄球菌(MRCNS)、耐甲氧西林金黄色葡萄球菌(MRSA)在血液中检出最高,鲍氏不动杆菌、产ESBLs肺炎克雷伯菌在痰液检出最高。革兰氏阳性菌对红霉素、青霉素、克林霉素耐药率高,而对替考拉宁、替加环素、呋喃妥因较敏感;革兰氏阴性菌对氨苄新林、头孢唑林、复方新诺明耐药率高,而对厄它培南、比阿培南、头孢噻吩较敏感。结论:自2013-2015年该三甲医院住院儿童多重耐药菌以革兰氏阳性菌为主,耐甲氧西林金黄色葡萄球菌(MRSA)呈上升趋势,产ESBLs肺炎雷伯菌、阴沟肠杆菌、鲍氏不动杆菌呈逐年下降趋势;检出的多重耐药菌主要对青霉素类、三代头孢菌素类、大环内酯类抗生素有较高的耐药率,尚未培养出对利奈唑胺、万古霉素耐药或中介的多重耐药菌,而对碳青霉烯类、加酶抑制剂复合制剂、糖肽类敏感性较高,但耐药率出现升高趋势,临床医师需明确感染部位及时送检细菌培养标本,选择正确、有效抗生素治疗,避免多重耐药菌产生及传播。
[Abstract]:Objective: to investigate the distribution and change trend of multidrug resistant bacteria (MDR) in hospitalized children in a third class hospital in Qingdao, and to analyze the drug resistance of multidrug resistant bacteria (MDR) detected in order to guide rational drug use in clinic. Methods: the multidrug resistant bacteria isolated from pediatric hospitalized children in Qingdao University Hospital from 2013 to 2015 were retrospectively analyzed and their distribution and drug resistance were analyzed statistically. Results: a total of 469 strains of pathogenic bacteria were isolated from a third Class A Hospital in Qingdao from 2013 to 2015. Among them 357 strains of multidrug resistant bacteria 208 strains of Gram-positive bacteria 145 strains of Gram-negative bacteria and 4 strains of fungi were isolated. MRCNS was the most common multidrug resistant bacteria, followed by Escherichia coli producing ESBLs. Methicillin-resistant Staphylococcus aureus (MRSAA) increased from 3.09% to 24.73% from 2013-2015, ESBLs producing Escherichia coli increased from 6.18% to 21.50% HLAR increased from 1.03% to 6.45%, ESBLs pneumoniae and Enterobacter cloacae increased. The detection rate of Acinetobacter baumannii decreased year by year. In general pediatrics, multidrug resistant bacteria accounted for 40.89% of total drug resistant bacteria, blood paediatrics 24.64% and Cenozoic 34.47.The highest detection rate was 56.58%, followed by urine 14.29m, sputum 8.96%, multidrug resistant coagulase negative staphylococcus MRCNSSs, resistant staphylococcus. MRSAs of Staphylococcus aureus were the highest detected in blood. Acinetobacter baumannii, ESBLs-producing Klebsiella pneumoniae in sputum detected the highest. Gram-positive bacteria were highly resistant to erythromycin, penicillin and clindamycin, but sensitive to teicoplanin, tegacycline and furantoin. But it is more sensitive to ertapenem, than Apenem and cefthiophene. Conclusion: Gram-positive bacteria were the main multidrug resistant bacteria in the hospitalized children of the third Class A Hospital from 2013 to 2015. MRSAs of methicillin-resistant Staphylococcus aureus showed an increasing trend, and the production of ESBLs pneumoniae, Enterobacter cloacae and Acinetobacter baumannii decreased year by year. The multidrug resistant bacteria were mainly resistant to penicillin, cephalosporins and macrolides, and had not been cultured to linazolamine, vancomycin resistant or intermediated multidrug resistant bacteria, but to carbapenems. The sensitivity of glycopeptide was higher than that of enzyme inhibitor compound preparation, but the rate of drug resistance was increasing. The clinicians should make sure that the infection site should be detected in time, and select the correct and effective antibiotic treatment. Avoid the production and transmission of multidrug resistant bacteria.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R446.5;R72

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