耐药性毕业论文格式模板范文关于抗药性和革兰氏阴性杆菌学士学位论文范文3000字有关写作资料-论文写作网

抗药性和革兰氏阴性杆菌论文范文

《2021－2021年某甲等医院非发酵革兰氏阴性杆菌的分布与耐药性分析》

本文是关于抗药性和革兰氏阴性杆菌毕业论文怎么写和耐药性类毕业论文怎么写.

摘要目的：為临床经验性治疗非发酵革兰氏阴性杆菌（NFGNB）感染提供参考依据.方法：收集陕西汉中市某甲等医院2010年1月-2019年12月临床送检的各类标本,回顾性分析NFGNB的分布及耐药情况.结果：2010-2019年,该院共检出病原菌26 386株,其中NFGNB 4 077株（占15.45%）,主要来源于年龄≥60岁的患者（1 836株,占45.05%）.10年间,NFGNB的检出率由2010年的20.14%降至2019年的15.36%（P<0.001）.检出菌种以鲍曼不动杆菌（1 359株）、铜绿假单胞菌（1 269株）、嗜麦芽窄食单胞菌（447株）、洋葱伯克霍尔德菌（351株）等为主.检出的NFGNB主要来源于住院患者（4 001株）,且多见于重症监护病区（占17.05%）、神经外科（占14.52%）、呼吸科（占12.41%）等科室以及呼吸道（占66.69%）、分泌物（占7.80%）等标本.其中,鲍曼不动杆菌和铜绿假单胞菌在肿瘤科的检出率以及在血液和尿液标本中的检出率均总体呈上升趋势,而在该院重症监护病区的检出率总体呈下降趋势（P<0.05）;铜绿假单胞菌在神经外科的检出率呈上升趋势（P<0.05）,鲍曼不动杆菌在呼吸科的检出率呈上升趋势（P<0.05）.鲍曼不动杆菌对碳青霉烯类抗菌药物的耐药率由2010年的10%左右升至2019年的75%左右,对头孢菌素类药物的耐药率超过了78%;铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别低于35%和30%,且耐药趋势变化不大（P>0.05）,而对哌拉西林、氨曲南等12种临床常用抗菌药物的耐药率均低于40%;嗜麦芽窄食单胞菌对复方磺胺甲噁唑的耐药率逐渐呈现下降趋势（P<0.001）,对头孢他啶的耐药率较高（54.70%～74.10%）;洋葱伯克霍尔德菌对复方磺胺甲噁唑、美罗培南、头孢他啶的耐药率均呈现下降趋势（P<0.01）,且在2014年之后均低于15%.结论：该院NFGNB的检出率虽有下降趋势,但鲍曼不动杆菌多重耐药和泛耐药情况较为严重,且对碳青霉烯类抗生素的耐药率有所上升;临床应根据药敏试验结果合理选用头孢哌酮/舒巴坦、阿米卡星、左氧氟沙星、头孢他啶等敏感药物治疗NFGNB感染.

关键词非发酵革兰氏阴性杆菌;耐药变迁;鲍曼不动杆菌;铜绿假单胞菌

ABSTRACTOBJECTIVE： To provide reference for clinical empirical treatment of non-fermentative Gram-negative bacilli （NFGNB） infection. METHODS： All kinds of clinical specimens were collected from Jan. 2010 to Dec. 2019 in a tertiary hospital from Hanzhong city of Shaanxi province; the distribution and drug resistance of NFGNB were analyzed retrospectively. RESULTS： A total of 26 386 strains of pathogenic bacteria were detected in the hospital during 2010-2019, including 4 077 strains of NFGNB （15.45%）, mainly from patients≥60 years old （1 836 strains, 45.05%）. During the 10 years, the detection rate of NFGNB decreased from 20.14% in 2010 to 15.36% in 2019 （P<0.001）. Acinetobacter baumannii （1 359 strains）, Pseudomonas aeruginosa （1 269 strains）, Stenotrophomonas maltophilia （447 strains） and Burkholderia cepacia （351 strains） were main pathogens. The detected NFGNB mainly came from hospitalized patients （4 001 strains）, and most of them were found in ICU （17.05%）, neurosurgery department （14.52%）, respiratory department （12.41%）, and respiratory tract （66.69%）, secretion （7.80%） specimens. The detection rates of A. baumannii and P. aeruginosa in oncology department, blood specimens and urine specimens showed an overall upward trend, while the detection rates in ICU of the hospital showed a downward trend （P<0.05）; the detection rate of P. aeruginosa in neurosurgery department showed an upward trend （P<0.05）, and that of A. baumannii in respiratory department showed an upward trend （P<0.05）. The resistance rate of A. baumannii to carbapenems increased from about 10% in 2010 to about 75% in 2019, and the resistance rate to cephalosporins exceeded 78%. The resistance rates of P. aeruginosa to imipenem and meropenem were lower than 35% and 30% respectively, and the trend of drug resistance did not change significantly （P>0.05）; the resistance rates to 12 kinds of clinically commonly used antibiotics as piperacillin and aztreonam were lower than 40%. The resistance rate of S. maltophilia to compound sulfamethoxazole showed a decreasing trend （P<0.001）, and the resistance rate to ceftazidime was high （54.70%-74.10%）. The resistance rates of B. cepacia to compound sulfamethoxazole, meropenem and ceftazidime showed a downward trend （P<0.01）, and were lower than 15% after 2014. CONCLUSIONS： Although the detection rate of NFGNB in our hospital showed a downward trend, the multi-drug resistance and pan-drug resistance of A. baumannii are serious, and the resistance rate to carbapenems is increased. Sensitive drugs such as cefoperazone/sulbactam, amikacin, levofloxacin and ceftazidime should be selected for NFGNB infection according to the results of drug sensitivity tests.

嗜麦芽窄食单胞菌和洋葱伯克霍尔德菌对多种抗菌药物天然耐药,且由于两种菌株广泛存在于医院环境中,可引发呼吸道感染、伤口感染以及尿路系统感染等,无疑会对长期住院、免疫力低下的易感染患者造成极大威胁[18-19].本研究结果显示,嗜麦芽窄食单胞菌对复方磺胺甲噁唑的耐药率逐渐呈现下降趋势;对左氧氟沙星的耐药率在小幅波动后,近3年（2017-2019年）内均在20%以下.洋葱伯克霍尔德菌对常用的复方磺胺甲噁唑、美罗培南、头孢他啶的耐药率也均呈现下降趋势,且从2014年以后,该菌对上述3种药物的耐药率均在15%以下.此外,嗜麦芽窄食单胞菌和洋葱伯克霍尔德菌在血液标本中的检出率分别为2.24%和3.42%,提示这2种病原菌所致血流感染也应得到临床的重视.

综上所述,NFGNB是引起院內感染的重要病原菌;2010-2019年,该院NFGNB的检出率虽呈下降趋势,但是鲍曼不动杆菌多重耐药和广泛耐药情况较为严重,且鲍曼不动杆菌和铜绿假单胞菌引起的血流感染有所增加.临床在抗感染治疗时,除减少感染风险因素外,还需根据药敏试验结果合理选用头孢哌酮/舒巴坦、阿米卡星、左氧氟沙星、头孢他啶等敏感药物,同时应严格实施院内感染防控,以降低耐药菌的感染与传播.

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（收稿日期：2020-07-16 修回日期：2020-09-28）

（编辑：张元媛）

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