烧伤科临床分离病原菌分布、耐药性及鲍曼不动杆菌分子流行病学分析

发布时间：2018-06-18 17:22

本文选题：烧伤 + 病原菌　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:了解我科2010-2014年临床分离细菌分布及耐药情况,了解近期鲍曼不动杆菌耐药基因情况,从而为临床有效控制感染、使用抗菌药物提供依据。方法:对2010年至2014年5年间入住本院烧伤病房并送检且培养结果阳性患者的临床资料进行回顾性分析。对临床收集的鲍曼不动杆菌,随机选取50株,采用PCR方法检测其9种常见耐药基因:bla KPC、bla IMP、bla VIM、bla NDM-1、bla OXA-23、bls OXA-24、bla OXA-48、bla OXA-51和bla OXA-58。结果:调查结果显示,烧伤因素和性别(χ2=24.318,P0.001)本次样本量内有统计学意义;烧伤程度与住院时间具有统计学意义(χ2=3,P0.05)。与此同时,菌株来源与病原菌分布同样具有显著统计学意义(χ2=29.632,P0.005),且检出部位前两位均为创面与分泌物。5年间共分离细菌542株中,相较革兰阳性菌(16.6%),2010-2014经统计学分析,呈递减趋势;革兰阴性菌(83.39%)多见。两类检出率首位的耐药率不容乐观。43.9%铜绿假单胞菌对头孢哌酮/舒巴坦耐药。葡萄球菌属中:奎奴普丁(1.27%)、复方新诺明(27.85%)和氯霉素(27.85%)敏感性较好外,两菌其余药物耐药率均大于50%。50株临床分离的鲍曼不动杆菌大多来自危重患者痰液标本;除美罗培南(17.20%),已对其余常用药物耐药率高达70%以上。考虑到年龄因素分组后,在革兰阳性菌中,金黄色葡萄球菌为婴幼儿组(13/19,68.42%)和儿童组(4/4,100%)的主要优势菌种。在革兰阴性菌中铜绿假单胞菌为三组中主要优势菌种,儿童组中比重显著大于(17/31,54.84%)婴幼儿组和成人组,后两组中其构成比无显著差异。金葡菌和其余革兰阳性菌普遍耐药率较高,婴幼儿组耐药率基本高于成人组水平。合成青霉素哌拉西林中,儿童耐药率(56.25%)显著小于其余两组。对50株鲍氏不动杆菌进行耐药基因筛查,经PCR分析发现,检出率最高为bla OXA-51-like基因(68.30%);其次为bla OXA-23-like基因,检出率32.79%。两类基因在多重耐药鲍曼不动杆菌的检出率均为非多重耐药菌两倍左右。检出bla OXA-58-like一株,但为非多重耐药菌。结论:革兰阳性菌感染率下降,铜绿假单胞菌和葡萄球菌属耐药性增加,主要与万古霉素和二线利奈唑胺使用以及早期削痂策略有关,而儿童检出革兰阳性菌高可能与儿童很少使用万古霉素和利奈唑胺有关,建议根据药敏结果合理选用抗菌药物。鲍曼不动杆菌以呼吸道传播为主,其较高的耐药率形势已十分严峻,碳青霉烯耐药基因主要以bla OXA-23,bla OXA-51耐药基因为主,多重耐药菌的流行也与之相关。
[Abstract]:Objective: to understand the distribution and drug resistance of clinical isolates in our department for 2010-2014 years, to understand the recent drug resistance gene of Acinetobacter Bauman, so as to provide the basis for the effective control of infection and the use of antibiotics. Methods: the clinical data of the patients who were admitted to the hospital from 2010 to 2014 and were checked and cultured for the positive patients in the hospital for 5 years. A retrospective analysis was performed. 50 strains of Acinetobacter Bauman were randomly selected and 9 common resistance genes were detected by PCR method: bla KPC, BLA IMP, BLA VIM, BLA NDM-1, BLA OXA-23. Statistical significance, the degree of burn and the time of hospitalization were statistically significant (x 2=3, P0.05). At the same time, the source of the strain and the distribution of pathogenic bacteria were equally significant (x 2=29.632, P0.005), and the first two of the detected sites were all 542 strains of bacteria separated from the wound and secretions during.5, compared with the Gram-positive bacteria (16.6%) and 2010-2014 Study analysis, subtraction trend, Gram-negative bacteria (83.39%) were more common. The drug resistance rate at the first of class two detection rates was not optimistic..43.9% Pseudomonas aeruginosa was resistant to Cefoperazone / sulbactam. In the genus Staphylococcus, quetiapin (1.27%), compound neorammine (27.85%) and chloramphenicol (27.85%) were more sensitive than 50, and the drug resistance rates of the other two bacteria were more than 50. The clinical isolates of%.50 strains of Acinetobacter from%.50 were mostly from the sputum of critically ill patients. In addition to meropenem (17.20%), the drug resistance rate of the other commonly used drugs was up to 70%. Considering the age group, Staphylococcus aureus was the main dominant strain in 13/19,68.42% and 4/4100%. Pseudomonas aeruginosa in Gram-negative bacteria was the main dominant strain in three groups. The proportion of children in children group was significantly greater than that of (17/31,54.84%) infant group and adult group, and there was no significant difference in the composition ratio in the latter two groups. The resistance rate of Staphylococcus aureus and other Gram-positive bacteria was higher than that in the adult group. In piperacillin, the resistance rate of children (56.25%) was significantly smaller than the other two groups. 50 strains of Acinetobacter baumannii was screened. The highest detection rate was bla OXA-51-like gene (68.30%) by PCR analysis, followed by bla OXA-23-like gene, and the detection rate of 32.79%. two genes in multidrug resistant Acinetobacter was not much more. BLA OXA-58-like was found to be about two times. A strain was detected, but it was non multidrug-resistant bacteria. Conclusion: the infection rate of Gram-positive bacteria decreased, the resistance of Pseudomonas aeruginosa and Staphylococcus increased, mainly related to the use of vancomycin and linezolid, and early eschar cutting strategy, and the detection of Gram-positive bacteria in children was likely to be very high with children. Less use of vancomycin and linezolid, it is suggested that antimicrobial agents should be selected rationally according to the results of drug sensitivity. Acinetobacter sp. Bauman is mainly with respiratory tract transmission, and its high drug resistance rate is very severe. The resistance genes of carbapenems are mainly bla OXA-23, BLA OXA-51 resistant basis, and the prevalence of multidrug-resistant bacteria is also related.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R644;R446.5

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