石家庄市烧伤患者感染病原菌分析及抗生素耐药性变迁

发布时间：2018-05-16 04:13

本文选题：烧伤 + 感染　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:分析我院烧伤科患者感染病原菌分布和耐药性及其变迁,以便指导临床用药。方法:收集2010年1月至2014年12月石家庄河北友爱医院烧伤科888例烧伤患者病原菌感染标本,进行细菌培养。采用全自动微生物鉴定系统进行细菌鉴定。采用K-B纸片法进行药物敏感试验。统计各年份病原菌检出分布和主要菌群的耐药性情况。结果:1 2010至2014年,我院烧伤患者送检标本病原菌检出率波动在30%左右,其中分离率居前五位依次为铜绿假单胞菌(36.71%)、金黄色葡萄球菌(22.86%)、大肠埃希菌(14.86%)、肺炎克雷伯菌(8.22%)和鲍曼不动杆菌(6.31%)。2铜绿假单胞菌整体检出率一直居高不下。金黄色葡萄球菌检出率2013年开始稍有下降趋势(P0.05)。金黄色葡萄球菌中耐甲氧西林的金黄色葡萄球菌(MRSA)检出率呈逐年递增的趋势(P0.01)。甲氧西林敏感的金黄色葡萄球菌(MSSA)检出率在5年间的变化差异无统计学意义。大肠埃希菌检出率自2010年以来有下降的趋势(P0.05)。肺炎克雷伯菌检出率在2014年有明显升高的趋势(P0.01),超过鲍曼不动杆菌检出率。3铜绿假单胞菌的耐药性自2012年以后呈逐年下降的趋势(P0.05),仅对环丙沙星和哌拉西林/他唑巴坦的耐药率呈逐年增高的趋势(P0.05)。鲍曼不动杆菌对头孢菌素、碳氢酶烯类和环丙沙星表现为较高的耐药性,对哌拉西林、哌拉西林/他唑巴坦、美罗培南和环丙沙星的耐药率均80%,仅对氨基糖苷类和四环素类药物敏感。大肠埃希菌对氨苄西林、头孢唑林和庆大霉素耐药率均80%,对其他类抗生素耐药性较低,但仍呈逐年增长的趋势(P0.05)。肺炎克雷伯菌的耐药情况相比其他主要病原菌来说较为乐观,仅对头孢呋辛和头孢唑林的耐药率较高,其他抗菌药物仍有较好的敏感性。4 2010-2014年MRSA耐药率均为100%的有3种,包括青霉素、苯唑西林和复方新诺明,耐药率80%的抗生素有8种,但MRSA对环丙沙星、左氧氟沙星和庆大霉素的耐药性呈逐年递减的趋势(P0.05),尚未发现利奈唑胺、万古霉素的耐药菌株。MSSA对青霉素和复方新诺明的耐药率80%,其次是红霉素和克林霉素,耐药率20%的抗生素有6种,包括苯唑西林、庆大霉素、环丙沙星、左氧氟沙星、利奈唑胺和万古霉素。结论:石家庄河北友爱医院烧伤科患者感染主要以铜绿假单胞菌感染和金黄色葡萄球菌感染为主,根据五年来的药敏结果和耐药性变迁情况正确选择有效抗菌药物进行治疗,对减少细菌耐药性的发生有重要意义。
[Abstract]:Objective: to analyze the distribution, drug resistance and changes of the pathogenic bacteria in the burn patients in our hospital in order to guide the clinical use. Methods: 888 specimens of the pathogenic bacteria infected by the burn patients from January 2010 to December 2014 in Hebei Friendship Hospital, Shijiazhuang, were collected and the bacteria were cultured. The bacterial identification was carried out by the automatic microbial identification system. The drug sensitivity test was carried out by K-B paper method. The distribution of pathogenic bacteria in each year and the drug resistance of major groups were analyzed. Results: from 12010 to 2014, the detection rate of pathogenic bacteria in the burned patients in our hospital fluctuated in about 30%, of which the top five were Pseudomonas aeruginosa (36.71%) and Staphylococcus aureus (22.86%). The overall detection rate of Escherichia coli (14.86%), Klebsiella pneumoniae (8.22%) and Acinetobacter Bauman (6.31%).2 Pseudomonas aeruginosa remained high. The detection rate of Staphylococcus aureus began to decrease slightly in 2013 (P0.05). The detection rate of Staphylococcus aureus (MRSA) in methicillin resistant Staphylococcus aureus was increasing year by year. (P0.01) there was no significant difference in the detection rate of methoxicillin sensitive Staphylococcus aureus (MSSA) in 5 years. The detection rate of Escherichia coli has declined since 2010 (P0.05). The detection rate of Klebsiella pneumoniae increased significantly in 2014 (P0.01), exceeding the detection rate of Acinetobacter Bauman.3 of Pseudomonas aeruginosa The drug resistance was decreasing year by year since 2012 (P0.05). The resistance rate of ciprofloxacin and piperacillin / tazobactam increased year by year (P0.05). Acinetobacter Bauman showed high resistance to cephalosporin, alkenes and ciprofloxacin, and piperacillin, piperacillin / tazobactam, meropenem and meropenem. The drug resistance rate of ciprofloxacin is 80%, only sensitive to aminoglycosides and tetracycline. The resistance rate of Escherichia coli to ampicillin, cefazolin and gentamicin is 80%, and the resistance to other antibiotics is low, but it is still increasing year by year (P0.05). To be optimistic, the drug resistance rate of cefuroxime and cefazolin was higher only. Other antibiotics still had good sensitivity to.4 2010-2014 year MRSA resistance rate of 3 species, including penicillin, oxacillin and compound sulfamethoxazole, and the antibiotic resistance rate 80% were 8, but MRSA was resistant to ciprofloxacin, levofloxacin and gentamicin. A trend of decreasing year by year (P0.05), linezolid was not found, the resistance rate of vancomycin resistant strain.MSSA to penicillin and compound penicillin was 80%, followed by erythromycin and clindamycin, and 6 kinds of antibiotics, including oxacillin, gentamicin, ciprofloxacin, levofloxacin, linezolid and vancomycin. The infection in the Department of burn department of Hebei Friendship Hospital in Shijiazhuang is mainly infected by Pseudomonas aeruginosa and Staphylococcus aureus. It is of great significance to reduce the occurrence of bacterial resistance according to the results of drug sensitivity and the change of drug resistance in the past five years.

【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】：R446.5;R644

【参考文献】