威海市医院感染病原菌变迁及耐药性的研究

发布时间：2019-05-07 09:08

【摘要】：目的：随着广谱扩生素的广泛使用，侵入性操作的增加，免疫机能低下的人群增多，医院感染病的原菌谱也发生了变化，耐药的细菌及真菌分离率也增加，成为医院感染的重要病原菌。医院感染的后果是不但增加了病人的住院时间，加重了病情，也增加了病人的经济负担，对社会、医院尤其对患者都产生了不良的影响。所以，研究医院感染的病原菌分布特点及年代变迁，对于预防和控制医院感染，提高病人的生活质量，增强病人的身体健康，缩短住院时间，降低病人的经济负担都具有非常重要的现实意义。本次研究的主旨在于研究医院感染病原菌分布特点以及耐药性的变化，为临床合理使用抗生素，增加临床医师的防范意识提供参考。方法：采用回顾性调查方法，随机抽取2006-2010年威海市三家医院共1775例医院感染患者送检的各类临床标本1285份，按《全国临床检验操作规程》进行接种、分离、培养。细菌分离培养按照美国临床实验室标准委员会（NCCLS）指导的原则，细菌培养基是M—H琼脂培养基，所有菌株利用德灵公司MicroScanauto SCAN4微生物全自动分析仪进行细菌鉴定，药敏试验采用二倍系列稀释法，结果判断根据NCCLS（2005年版）标准进行判断。真菌送检标本的接种、分离、培养、鉴定和药敏试验均由微生物室按《全国临床检验操作规程》应用珠海黑马生物工程有限公司生产的Bact-IST微生物分析系统及其配套的鉴定卡、药敏卡完成。结果：1285份标本检出病原菌1145株，阳性检出率89.11%，其中革兰阴性菌435株，占38.01%；革兰阳性菌383株，占33.4%；真菌327株，占28.55%。主要菌株为白色假丝酵母菌（12.14%）、大肠埃希菌（11.10%）、粪肠球菌（12.05%）、铜绿假单胞菌（7.17%）、肺炎克雷伯菌（4.90%）；5年大肠埃希菌的分离率呈递减趋势(2006年13.95%、2007年8.67%、2008年8.81%、2009年12.27%、2010年12.06%)，，铜绿假单胞菌的分离率有逐年增高现象（2006年3.10%、2007年5.10%、2008年6.17%、2009年9.39%、2010年8.89%)；真菌检出率5年比较平稳（2006年23.26%、2007年29.08%、2008年29.52%、2009年29.60%、2010年28.57%），亚胺培南是大肠埃希菌、阴沟肠杆菌、鲍曼不动杆菌敏感性最高的抗菌药物；铜绿假单胞菌对红霉素、环丙沙星、亚胺培南的耐药率比较低；肺炎克雷伯菌对亚胺培南、氨苄西林的耐药率低；粪肠球菌对氨曲南、氨苄西林的耐药率较低，葡萄球菌对环丙沙星的耐药率最低。而5-氟胞嘧啶和两性霉素B是假丝酵母菌敏感性最高的药物。结论：医院感染的病原菌大多为条件致病菌，不同年份、不同医院临床感染的病原菌的种类、构成有所不同；加强医院感染病例的细菌学监测和动态分析，结合药敏试验结果，合理选择抗菌药物，对开展感染病学的研究、制定有效的感染控制措施、杜绝感染暴发流行具有积极意义。
[Abstract]:Objective: with the widespread use of broad-spectrum probiotics and the increase of invasive manipulation, the number of people with low immune function increased, the bacterial spectrum of nosocomial infection also changed, and the isolation rate of drug-resistant bacteria and fungi also increased. It has become an important pathogen of nosocomial infection. The result of hospital infection is that it not only increases the patient's hospitalization time, but also increases the patient's economic burden. It has a bad influence on the society and the hospital, especially on the patient. Therefore, in order to prevent and control nosocomial infection, improve the quality of life of patients, enhance the health of patients and shorten the length of hospital stay, we should study the distribution characteristics and chronological changes of pathogenic bacteria in hospital infection. It is of great practical significance to reduce the financial burden of patients. The main purpose of this study is to study the distribution characteristics of nosocomial infection pathogens and the change of drug resistance in order to provide reference for the rational use of antibiotics in clinic and the increase of clinicians' awareness of prevention. Methods: 1285 clinical specimens of 1775 patients with nosocomial infection were randomly selected from three hospitals in Weihai City from 2006 to 2010 by retrospective investigation. The samples were inoculated, separated and cultivated according to the National practice of Clinical Inspection. In accordance with the principles of (NCCLS), the bacterial culture medium is Mh Agar medium. All strains are identified by MicroScanauto SCAN4 automatic microbe analyzer of Deling Company, and the bacteria are separated and cultured in accordance with the principles of the American Clinical Laboratory Standards Committee of the United States of America. The drug sensitivity test was performed by double series dilution method. The results were judged according to the NCCLS (2005 edition) standard. Inoculation, isolation, culture of fungi for examination, The identification and drug sensitivity test were carried out by the microbiological laboratory according to the National practice of Clinical Inspection. The Bact-IST microbiological analysis system produced by Zhuhai Black Horse Bioengineering Co., Ltd and its matching identification card and drug sensitive card were used. Results: 1145 strains of pathogenic bacteria were detected in 1285 samples, the positive rate was 89.11%, of which 435strains were Gram-negative bacteria (38.01%), 383 strains (33.4%) were Gram-positive bacteria, 327strains (28.55%) were fungi. The main strains were Candida albicans (12.14%), Escherichia coli (11.10%), Enterococcus faecalis (12.05%), Pseudomonas aeruginosa (7.17%) and Klebsiella pneumoniae (4.90%). (13.95% in 2006, 8.67% in 2007, 8.81% in 2008, 12.27% in 2009 and 12.06% in 2010). The isolation rate of Pseudomonas aeruginosa increased year by year (3.10% in 2006, 5.10% in 2007, 6.17% in 2008, 9.39% in 2009 and 8.89% in 2010). The detection rate of fungi was stable for 5 years (23.26% in 2006, 29.08% in 2007, 29.52% in 2008, 29.60% in 2009 and 28.57% in 2010), and imipenem was Escherichia coli and Enterobacter cloacae. Acinetobacter baumannii and Acinetobacter baumannii were the most sensitive antibiotics. The resistance rate of Pseudomonas aeruginosa to erythromycin, ciprofloxacin and imipenem was lower than that of Klebsiella pneumoniae to imipenem and ampicillin. The resistance rate of Enterococcus faecalis to ampicillin and ampicillin was lower than that of staphylococcus to ciprofloxacin. 5-fluorocytosine and amphotericin B were the most sensitive drugs of Candida spp. Conclusion: most of the pathogens of nosocomial infection are conditional pathogens, and the types and compositions of the pathogens in different years and different hospital clinical infections are different. Strengthening the bacteriological monitoring and dynamic analysis of nosocomial infection cases, combining with the results of drug sensitivity test, reasonably selecting antibacterial drugs are of positive significance for the research of infectious diseases, the formulation of effective infection control measures and the prevention of the outbreak of infection.
【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】：R446.5;R181.3

【参考文献】