特发性肺间质纤维化住院患者痰培养病原菌分布及耐药性分析

发布时间：2018-04-05 00:17

本文选题：特发性肺间质纤维化　切入点：急性加重　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:探讨特发性肺间质纤维化(IPF)住院患者痰培养病原菌分布及耐药情况,为经验性抗感染治疗提供依据。方法:通过我院病案室国际疾病编码查询系统,使用疾病编码J84.001(肺泡蛋白沉积症)、J84.101(肺纤维化)、J84.104(特发性肺间质纤维化)、J84.105(间质性纤维性肺泡炎)、J84.106(弥漫性肺间质纤维化)、J84.108(机化性肺炎)、J84.109(炎症后纤维化)、J84.800(特指间质性肺病)、J84.803(肺弥漫性间质病变)、J84.900(间质性肺病)查询我院2014年10月-2016年10月符合上述检索条件的住院患者,筛选出临床资料完整、符合IPF诊断标准、并因呼吸困难急性恶化住院者,分析其痰培养病原菌分布及耐药性,应用SPSS21.0进行统计学处理。结果:按上述检索条件,共检索出病例639例,其中符合IPF诊断标准、因呼吸困难急性恶化住院者共102例,共送检369次痰培养检查,分离出68株原菌,阳性率为18.43%。其中革兰阴性杆菌46株(67.65%),前四位的分别为鲍曼不动杆菌、肺炎克雷伯杆菌、铜绿假单胞菌、大肠埃希菌,革兰阳性菌5株(5.88%),金黄色葡萄球菌居首位。真菌16株(23.53%),主要为白假丝酵母菌。鲍曼不动杆菌对替加环素、头孢哌酮钠舒巴坦钠、阿米卡星的耐药率分别为0、13.33%、26.67%,对其他细菌的耐药率均大于60%。肺炎克雷伯杆菌对头孢哌酮钠舒巴坦钠、头孢替坦、头孢曲松、呋喃妥因、头孢吡肟、庆大霉素、亚胺培南、复方新诺明、头孢他啶、妥布霉素、阿米卡星、美罗培南、哌拉西林他唑巴坦耐药率均低于30%。铜绿假单胞菌对头孢哌酮钠舒巴坦钠、阿米卡星、美罗培南、头孢他定、亚胺培南、妥布霉素、环丙沙星、头孢吡肟、庆大霉素、盐酸左氧氟沙星均低于40%,对哌拉西林他唑巴坦、哌拉西林、氨曲南的耐药率为40%,而对氨苄西林、头孢曲松、头孢替坦、呋喃妥因的耐药率均为90%。大肠埃希菌对亚胺培南、阿米卡星、美罗培南的耐药率均为11.11%,对头孢哌酮钠舒巴坦钠、妥布霉素、哌拉西林他唑巴坦的耐药率均为22.22%,对环丙沙星、头孢替坦、庆大霉素的耐药率均为33.33%,对头孢他定的耐药率均为44.44%,对左氧氟沙星、头孢吡肟、氨曲南、头孢曲松的耐药率为55.56%,对呋喃妥因、头孢呋辛、复方新诺明、氨苄西林及哌拉西林的耐药率均大于70%。分离的革兰氏阳性细菌对万古霉素、替加环素、喹努普汀/达福普汀、利奈唑胺敏感率均为100%。分离的病原菌均对氟康唑、伊曲康唑、伏立康唑敏感。结论:IPF住院患者痰培养病原菌主要为革兰阴性杆菌,其次是真菌,革兰阳性球菌所占的比例较少。革兰阴性杆菌中,鲍曼不动杆菌的检出率高、耐药性强、耐菌谱广,对碳青酶烯类药物耐药率较高,而对替加环素、头孢哌酮钠舒巴坦钠、阿米卡星耐药率较低,可作为治疗选择,而其他革兰阴性杆菌对碳青霉烯类、β-内酰胺类抗生素/酶抑制剂复合制剂、氨基糖苷类抗生素仍保持较高的敏感性。在革兰阳性球菌感染的病原菌中,未发现对替加环素、利奈唑胺、万古霉素耐药的菌株,治疗中可选用上述药物。同时应该警惕真菌感染,白色假丝酵母菌仍然是IPF合并真菌感染最常见的致病菌。
[Abstract]:Objective: To investigate the idiopathic pulmonary fibrosis (IPF) culture of pathogen distribution and drug resistance in patients with sputum, to provide the basis for empirical anti infective therapy. Methods: the Department of medical records international disease encoding query system, using J84.001 encoding disease (Pap), J84.101 (pulmonary fibrosis), J84.104 (idiopathic pulmonary fibrosis (J84.105), interstitial fibrosing alveolitis (J84.106), diffuse pulmonary interstitial fibrosis (J84.108), organizing pneumonia (J84.109), inflammatory fibrosis (especially J84.800), interstitial lung disease (J84.803), diffuse pulmonary interstitial lesions), J84.900 (ILD) query in our hospital in October 2014 -2016 year in October in accordance with the search condition in hospitalized patients, screening out the complete clinical data, meet the criteria for the diagnosis of IPF, and because of dyspnea acute exacerbation of the hospitalized, analyze the sputum culture distribution and drug resistance of pathogenic bacteria, the application of SPSS21.0 Data were analyzed statistically. Results: according to the retrieval conditions, a total of 639 cases, which were consistent with the diagnostic criteria of IPF, acute deterioration due to breathing difficulties hospitalized a total of 102 cases, 369 were from sputum culture examination, 68 strains of pathogenic bacteria, the positive rate of 18.43%. among 46 strains of gram negative bacilli (67.65%) four, respectively Bauman Acinetobacter, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, 5 strains of gram positive bacteria (5.88%), Staphylococcus aureus ranked first (23.53%). 16 strains of fungi, mainly Candida albicans. Bauman Acinetobacter of tegafur minocycline and cefoperazone sodium and sulbactam sodium, Amikacin drug resistance rates were 0,13.33%, 26.67%, resistant to other bacteria were more than 60%. of Klebsiella pneumoniae of cefoperazone sodium and sulbactam sodium, cefotetan, ceftriaxone, nitrofurantoin, gentamicin, cephalosporin cefepime, imipenem, compound Sulfamethoxazole, ceftazidime, tobramycin, Amikacin, meropenem, piperacillin tazobactam resistance rates were lower than the 30%. of Pseudomonas aeruginosa to cefoperazone sulbactam, Amikacin, ceftazidime, meropenem, imipenem, tobramycin, ciprofloxacin, cefepime, gentamicin, levofloxacin hydrochloride were lower than 40% that of piperacillin tazobactam, piperacillin, aztreonam ammonia resistant rate was 40%, and ceftazidime to ampicillin, ceftriaxone, cefotetan, nitrofurantion were Amikacin 90%. of Escherichia coli to imipenem, meropenem amine, drug resistance rate was 11.11%, tobramycin of cefoperazone sodium sulbactam, and piperacillin tazobactam resistance rate was 22.22%, cefotetan, ciprofloxacin, gentamicin resistance rate was 33.33%, he set on cephalosporin resistance rate were 44.44%, of levofloxacin, ceftazidime Cefepime, aztreonam, ceftriaxone resistant rate was 55.56%, of nitrofurantoin, cefuroxime, cotrimoxazole, gram positive bacteria resistant ampicillin and piperacillin were greater than 70%. separation of vancomycin, tigecycline, quinupristin / Dafoe and leptin, linezolid sensitive rate as the pathogen 100%. isolated were sensitive to fluconazole, itraconazole, Fushita Yasu. Conclusion: IPF in patients with sputum culture the main pathogens were gram negative bacilli, followed by fungi, gram positive cocci accounted for less. Gram negative bacilli in Bauman Acinetobacter high detection rate, strong resistance, resistance a broad spectrum of bacteria, high carbopenems resistant rate of tigecycline, cefoperazone sodium and sulbactam sodium, Amikacin low resistance rate, can be used as a treatment option, while other gram negative bacilli to carbapenems, beta lactam antibiotics / enzyme Inhibitor, aminoglycoside antibiotics still maintain high sensitivity. In gram positive cocci infection of pathogenic bacteria, not found on tigecycline and linezolid, vancomycin resistant strains, the selection of drugs in the treatment. At the same time should be wary of fungal infection, Candida albicans is still the most pathogenic bacteria the common IPF complicated with fungal infection.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563

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