近三年我科烧伤感染细菌学分析

发布时间：2018-03-18 11:11

本文选题：烧伤　切入点：途径　出处：《广西医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的定期监测广西医科大学第一附属医院烧伤病房烧伤感染患者的病原菌种类及感染途径和细菌耐药情况,为临床预防和治疗感染提供参考依据。方法采用回顾性调查方法,收集广西医科大学第一附属医院烧伤病房2012年1月到2014年12月间烧伤感染患者的性别、年龄、烧伤原因、烧伤面积、住院时间、病原菌种类、感染途径和药敏情况等。结果烧伤感染患者共326人,分离出非重复病原菌共589株,感染途径5种。1.检出革兰阴性杆菌408株占69.3%、革兰阳性球菌137株占23.3%和真菌44株占7.5%。2.烧伤感染途径共5种：烧伤创面占第一位(517株占87.8%),其次是静脉导管(33株占5.6%),呼吸道(30株占5.1%)、尿路(6株占1%)和血液(3株占0.5%)。3.检出率居前八位的病原菌由高至低为：鲍曼不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌、粪肠球菌、奇异变形杆菌。4.不同季节检出前八位的病原菌中,各种细菌检出率有季节性意义。5.不同烧伤原因中,鲍曼不动杆菌在火焰烧伤中检测率高。6.烧伤面积大于等于50%组与小于50%组细菌分布有差别。7.主要革兰阳性球菌药敏情况：金黄色葡萄球菌对利奈唑胺、替加环素、万古霉素的耐药率均为0。耐甲氧西林金黄色葡萄球菌MRSA占43.3%。8.三种主要革兰阴性杆菌药敏情况：对鲍曼不动杆菌,左氧氟沙星总耐药率为46.5%,对其他抗生素耐药率在77%-94.8%。对铜绿假单胞菌,总的耐药率不高,其中最低的3位是哌拉西林他唑巴坦27.5%。阿米卡星30.4%,亚胺培南33.3%。对肺炎克雷伯菌,亚胺培南的总耐药率为7.7%,最高的为复方新诺明74.4%结论：通过综合分析烧伤患者的感染途径,病原菌和药敏情况,加强相关监测,做好预见性干预措施,提高烧伤感染的诊疗水平。1.各种感染途径中,创面感染是主要的感染途径。2.革兰阴性杆菌的检出率远远高于革兰阳性球菌,可能与本地区的特殊气候有关。3.各种细菌检出率有季节性意义。4.鲍曼不动杆菌的耐药率总体偏高,值得引起临床的重视。5.万古霉素仍是治疗金黄色葡萄球菌感染的有效药物。6.各种细菌多重耐药情况日趋严重,对合理应用抗生素提出更高要求。
[Abstract]:The type of pathogenic bacteria and drug resistance in patients with bacterial infection and the infection of burn burn wards of the First Affiliated Hospital of Guangxi Medical University to regularly monitor and provide reference for clinical prevention and treatment. Methods Retrospective investigation, collecting the First Affiliated Hospital of Guangxi Medical University from January 2012 to December 2014 in burn ward burn infection in patients with sex, age, cause of burns. Burn area, hospitalization time, pathogens, infection and drug sensitivity. Results the infection of burn patients with a total of 326 people, isolated 589 strains of bacteria were not repeated, infection of 5.1. detected 408 strains of gram negative bacilli accounted for 69.3%, gram positive cocci accounted for 23.3% and 137 strains of fungi were 44 7.5%.2. infection were 5: burn burn wound for the first (517 strains, 87.8%), followed by venous catheter (33 strains accounted for 5.6% (30 strains), respiratory tract, urinary tract (5.1%) 6 strains accounted for 1%) and blood (3 strains 0.5%) pathogen detection rate of.3. in the top eight from high to low: Bauman Acinetobacter, Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, Enterococcus faecalis, Enterobacter cloacae, proteus..4. is not the same season as one of the top eight pathogenic bacteria, bacteria detection rate of seasonal.5. different burn causes, Bauman Acinetobacter detection in the high rate of.6. flame burn in burn area is greater than or equal to 50% and less than 50% group group of bacteria distribution difference of.7. mainly gram positive cocci susceptibility: Gold aureus to linezolid, tigecycline and vancomycin resistance rate was 0. MRSA in methicillin-resistant Staphylococcus aureus accounted for 43.3%.8. of three gram negative bacilli susceptibility of Bauman Acinetobacter, levofloxacin total drug resistance rate was 46.5%, on the other. Hormone resistance rate of 77%-94.8%. of Pseudomonas aeruginosa, the total resistance rate is not high, the lowest is 3 piperacillin tazobactam 27.5%. Amikacin 30.4%, Klebsiella pneumoniae imipenem 33.3%., total imipenem resistance was 7.7%, the highest for the SMZ-TMP 74.4% conclusion comprehensive analysis of infection in burn patients, pathogen and drug sensitivity, strengthen monitoring, foreseen intervention measures to improve the level of diagnosis and treatment of.1. infection of burn infection in various ways, wound infection is.2. was the main infection of gram negative bacilli far higher than the rate of gram positive cocci, with special local climate the.3. detection rate of bacterial resistance to seasonal.4. Bauman Acinetobacter rate is high, is the treatment of staphylococcal infections caused by effective clinical importance to vancomycin is still.5. The multidrug resistance of various bacteria in the drug.6. is becoming more and more serious, and it is more demanding for the rational use of antibiotics.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R644

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