大连市儿童医院住院患儿咽部阴性杆菌的携带状况分析

发布时间：2018-03-28 01:40

本文选题：革兰阴性菌　切入点：ESBL　出处：《大连医科大学》2012年硕士论文

【摘要】：目的：本研究的目的是以大连市儿童医院呼吸病房住院患儿为对象，，了解其鼻咽部革兰阴性菌携带的分布，监测产ESBL革兰氏阴性杆菌的流行以及药物敏感状况，为临床提供合理使用抗生素的依据。方法：选择入住大连市儿童医院患者有呼吸系统感染的患者进行预期的一年研究，时间2010年1月到2010年12月。随机选取1190例住院患者进行咽拭子培养，所有标本在巧克力培养基上进行微生物培养，应用革兰氏染色和标准化测定分离鉴别的菌落。产ESBL酶革兰氏阴性菌分离，抗微生物敏感性应用K-B法测定进行。结果：1190例患儿中，男性患儿764例（64.2%），女性426例（35.8%）。208例患儿咽部检出革兰阴性菌定植，阳性率17.5%（208/1190），有18种菌株，主要包括鲍曼不动杆菌21.2%（44/208），大肠杆菌19.2%（40/208），肺炎克雷伯杆菌12.5%（26/208），流感嗜血杆菌12%（25/208），绿脓杆菌11.1%（23/208），产ESBLS菌株10.1%（21/208），混合感染者9.6%（20/208），其中13例是混合感染肠球菌，208例革兰阴性菌株培养阳性病例中，男性患儿173例（83.2%），女性患儿35例（16%），性别比例有统计学意义（P0.05）。产ESBLS菌株占革兰氏阴性杆菌感染的10.1%，产ESBLS大肠杆菌占81%，产ESBLS肺炎克雷伯杆菌占19%。所有产ESBLS的菌株对下列抗生素的耐药率增加，分别是头孢对噻肟95.2%，头咆哌酮95.2%，头孢曲松95.2%，头孢他啶95.2%和头孢吡肟100%；对下列抗生素敏感，敏感率分别是美洛西林/舒巴坦95.2%和哌拉西林/舒巴坦95.24%、头孢西汀90.5%和亚胺培南100%。结论：鲍曼不动杆菌是大连儿童医院急性呼吸道感染最常见的革兰氏阴性杆菌，大肠杆菌是产ESBL株最多的革兰氏阴性杆菌。所有的产ESBL的革兰氏阴性菌对头孢菌素类药物（头孢噻肟、头咆哌酮、头孢曲松、头孢他啶和头孢吡肟）耐药，对含有舒巴坦的内酰胺类药物和头孢西汀和碳青酶烯类药物敏感，因此,产ESBL株引起的急性呼吸道感染应选择含有舒巴坦的内酰胺类药物、头孢西汀和碳青酶烯类药物进行治疗。
[Abstract]:Objective: to investigate the distribution of Gram-negative bacteria in nasopharynx and to monitor the prevalence and drug sensitivity of Gram-negative bacilli producing ESBL in respiratory ward of Dalian Children's Hospital. To provide the basis for rational use of antibiotics in clinic. Methods: a prospective one year study of 1190 hospitalized patients with respiratory infection from January 2010 to December 2010 was carried out in Dalian Children's Hospital. All the specimens were cultured on chocolate medium and identified by Gram staining and standardised. ESBL producing Gram-negative bacteria were isolated and the antimicrobial sensitivity was determined by K-B method. Results of the 1190 children, 764 were male and 426 were female, 35.80.208 children had Gram-negative bacteria colonized in pharynx, and the positive rate was 17.5% 208 / 1190%. There were 18 strains of Gram-negative bacteria. These include Acinetobacter baumannii 21.2um 44 / 208, Escherichia coli 19.2208m, Klebsiella pneumoniae 12.526 / 208m, Haemophilus influenzae 1225 / 208m, Pseudomonas aeruginosa 11.1cum / 23R / 208G, ESBLS producing strain 10.1 / 21 / 208R, mixed infection 9.62020 / 208N, among them 13 cases were mixed with Enterococcus enterococci positive for Gram negative strains. 173 cases of male and 35 cases of female, the sex ratio is statistically significant (P 0.05). The ESBLS producing strains accounted for 10.1% of Gram-negative bacilli infection, the production of ESBLS Escherichia coli accounted for 81%, and the production of ESBLS Klebsiella pneumoniae accounted for 19.1%. Increased antibiotic resistance, Cefoperazone 95.2%, ceftriaxone 95.2%, ceftazidime 95.2% and cefepime 100 were sensitive to the following antibiotics: meloxicillin / sulbactam 95.2%, piperacillin / sulbactam 95.24, cefoxetine 90.5% and imipenem 100m. Conclusion: Acinetobacter baumannii is the most common Gram-negative bacilli in children's hospital acute respiratory tract infection in Dalian. E. coli is the most gram-negative bacilli producing ESBL strains. All ESBL producing gram-negative bacteria are resistant to cephalosporins (cefotaxime, cephaloperazone, ceftriaxone, ceftazidime and cefepime). Lactams containing sulbactam and cefoxetine and carbenes are sensitive to these drugs. Therefore, lactams containing sulbactam should be selected for acute respiratory infections caused by ESBL strains. Cefoxetine and carbocyanenes were treated.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R766

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