下呼吸道感染患者的病原菌分布及耐药分析

发布时间：2018-04-17 14:09

本文选题：下呼吸道 + 病原菌分布　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:对下呼吸道感染病原体的研究随着调查区域和范围的不同会有很大的区别,所以本次研究以我院下呼吸道感染病人痰液标本作为研究对象,进行细菌培养及药敏试验,对大量实验结果进行分析总结,最后得出我院下呼吸道感染患者致病微生物的最新分布数据及耐药特点,并对资料进行进一步的挖掘,用最新的分布数据及耐药特点与我院公布的上一年的感染调查报告作比较分析,得出致病菌分布及耐药特性的变迁。以给予临床参考,促进抗生素的合理运用。方法:收集我院2016年1月1日至2016年12月31日我院病人的下呼吸道感染患者中痰液标本,培养后如果在同一份痰液标本中,生长超过三种及以上的细菌,则认定为痰液污染,如果有两种细菌,则选取优势菌进行鉴定和药敏分析。用法国生物梅里埃细菌鉴定仪和DADE BEHRING全自动微生物鉴定仪进行细菌鉴定和药敏试验。所有菌株鉴定到种,必要时采用传统生化方法和K—B法进行补充鉴定。药敏试验验结果判定标准按2012年版《抗微生物学药物敏感性试验执行标准》规定执行。结果:2016年1月1日至2016年12月31日共收集痰液标本5743份,其中检出阳性标本1379份,阳性率为24%。各种细菌检出率:铜绿假单胞菌22%;鲍曼不动杆菌17%;肺炎克雷伯菌肺炎亚种14%;大肠埃希菌10%;肺炎链球菌9%;金黄色葡萄球菌金黄亚种8%;卡他摩拉菌4%;白色念珠菌2%;阴沟肠杆菌2%;产气肠杆菌2%;其它10%。结论:2016年下呼吸道感染病原菌前五位分别是:铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌肺炎亚种、大肠埃希菌、肺炎链球菌。与2015年相比,鲍曼不动杆菌的比例有较大提高,肺炎链球菌也进入到前五位。各种病原菌对氨苄西林的耐药率均达到了80%以上,该抗生素不宜用于临床治疗。在铜绿假单胞菌感染的治疗中头孢吡肟、妥布霉素、左旋氧氟沙星、哌拉西林/他唑巴坦、氨曲南、哌拉西林、庆大霉素、替卡西林/克拉维酸和环丙沙星的耐药率效果较好。头孢他啶、亚胺培南、美洛培南、阿米卡星最有效药物。鲍曼不动杆菌耐药性分析中发现其对几乎所有抗生素耐药,且分离出该种菌的标本几乎全部来自ICU,建议医院要加强对ICU医院感染的检测。肺炎克雷伯菌的耐药特性较弱,仅对氨苄西林的耐药达到80%以上。厄他培南、亚胺培南、美洛培南和阿米卡星是治疗大肠埃希菌感染的最佳药物。替卡西林/克拉维酸、哌拉西林/他唑巴坦和头孢西丁属于有效药物。在下呼吸道感染中,各种病原菌的比率会随着时间的推移而发生变化,其耐药性也会反生很大变化,且与抗生素的运用原则和频率有相关性,应加强药敏监测与分析,及时的为指导临床合理运用抗生素提供科学依据。
[Abstract]:Objective: the research on pathogens of lower respiratory tract infection will be very different with the different investigation area and scope, so this study takes the sputum samples of patients with lower respiratory tract infection in our hospital as the research object, carries on the bacteria culture and the drug sensitivity test.A large number of experimental results were analyzed and summarized. Finally, the latest distribution data and drug resistance characteristics of pathogenic microorganisms in patients with lower respiratory tract infection in our hospital were obtained, and the data were further excavated.By comparing the latest distribution data and drug resistance characteristics with the infection investigation report published by our hospital last year, the changes of the distribution and drug resistance characteristics of pathogenic bacteria were obtained.To provide clinical reference to promote the rational use of antibiotics.Methods: sputum samples from patients with lower respiratory tract infection from January 1, 2016 to December 31, 2016 in our hospital were collected.If there are two kinds of bacteria, the dominant bacteria are selected for identification and drug sensitivity analysis.The bacteriological identification and drug sensitivity test were carried out by using the French Bio-Merier bacteria Identification instrument and DADE BEHRING automatic Microbiological Identification instrument.All strains were identified by traditional biochemical method and K-B method when necessary.The results of drug sensitivity test were determined according to the execution standard of anti-microbiological drug sensitivity test in 2012.Results: from January 1, 2016 to December 31, 2016, a total of 5743 sputum samples were collected, of which 1379 were positive, with a positive rate of 24.Detection rate of various bacteria: Pseudomonas aeruginosa 22; Acinetobacter baumannii 17; Klebsiella pneumoniae subspecies 14; Escherichia coli 10; Streptococcus pneumoniae 9; Staphylococcus aureus gold subspecies 8; Morrah katamora 4; Candida albicans 2;Enterobacter cloacae 2; Enterobacter aerogenes 2; other 10.Conclusion: the top five pathogens of lower respiratory tract infection in 2016 are Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae pneumonia subspecies, Escherichia coli and Streptococcus pneumoniae.Compared with 2015, Acinetobacter baumannii increased significantly, and Streptococcus pneumoniae entered the top five.The resistance rate of various pathogens to ampicillin was more than 80%, and the antibiotic was not suitable for clinical treatment.In the treatment of Pseudomonas aeruginosa infection, cefepime, tobramycin, levofloxacin, piperacillin / tazobactam, aztreonam, piperacillin, gentamicin, tekacillin / clavulanic acid and ciprofloxacin were better.Ceftazidime, imipenem, meropenem, amikacin are the most effective drugs.In drug resistance analysis of Acinetobacter baumannii, it was found that it was resistant to almost all antibiotics, and almost all samples isolated from Acinetobacter baumannii were from ICU. It was suggested that hospital should strengthen the detection of ICU nosocomial infection.The resistance of Klebsiella pneumoniae to ampicillin was more than 80%.Ertapenem, imipenem, meropenem and amikacin are the best drugs for the treatment of Escherichia coli infection.Tecacillin / clavulanic acid, piperacillin / tazobactam and cefoxitin are effective drugs.In the infection of lower respiratory tract, the ratio of various pathogens will change with the passage of time, and the drug resistance will also change greatly, and it is related to the principle and frequency of antibiotic use, so the surveillance and analysis of drug sensitivity should be strengthened.To provide scientific basis for guiding the rational use of antibiotics in clinical practice.
【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;R56

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