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目的分析重症监护病房患者继发脑膜败血伊丽莎白菌感染的临床病因和耐药特点,为临床治疗和预防脑膜败血伊丽莎白菌感染提供依据。方法收集2011年1月至2014年12月重症监护病房患者临床标本,常规分离培养细菌,K-B纸片法进行药敏试验,利用WHONET 5.6软件分析处理试验数据。结果造成脑膜败血伊丽莎白菌主要危险因素有中央静脉插管、应用广谱抗生素、严重的基础疾病、使用免疫抑制剂、入住ICU时间等;检出的71例阳性标本以下呼吸道为主,占87.3%,其次为血液和尿液,分别占5.6%和2.8%;药敏试验表明脑膜败血伊丽莎白菌对万古霉素、磺胺甲唑/甲氧苄啶、利福平和米诺环素的耐药率最低,分别为0.0%、15.5%、16.9%和18.3%,对三种含酶抑制剂的耐药率均<30.0%,其余抗菌药物除环丙沙星、左氧氟沙星外,均>85.0%。结论脑膜败血伊丽莎白菌引发的医院感染已日益严重,该菌对临床常用的头孢类、碳青霉烯类、氨基糖苷类及多种β-内酰胺类抗生素呈高度耐药,临床应加强耐药性监测,防止医院感染,治疗脑膜败血伊丽莎白菌感染首选万古霉素、磺胺甲唑/甲氧苄啶、米诺环素、利福平和含酶抑制剂。
Objective To analyze the clinical etiology and drug resistance characteristics of Elisabeth bacteria infection in patients with secondary meningoencephalitis in intensive care unit and provide basis for clinical treatment and prevention of infection of Elizabeths. Methods Clinical samples of patients in intensive care unit from January 2011 to December 2014 were collected. Bacteria and K-B method were used to conduct drug susceptibility testing. The data were analyzed by WHONET 5.6 software. Results The main risk factors for meningeal septicemia were central venous catheterization, broad-spectrum antibiotics, severe underlying diseases, immunosuppressive agents, ICU admission time, etc .; 71 positive samples were detected following respiratory tract, accounting for 87.3 %, Followed by blood and urine, accounting for 5.6% and 2.8%, respectively; drug susceptibility tests showed that drug resistance to vancomycin, sulfamethoxazole / trimethoprim, rifampin and minocycline The lowest rates were 0.0%, 15.5%, 16.9% and 18.3%, respectively. The resistance rate to all three inhibitors was less than 30.0%. The remaining antibiotics except ciprofloxacin and levofloxacin were all> 85.0%. Conclusion The infection of nosocomial infection caused by Meningeal septicemia and Elizabethse bacteria has become increasingly serious. The bacteria are highly resistant to cephalosporins, carbapenems, aminoglycosides and various β-lactam antibiotics commonly used in clinical practice. Pharmacological monitoring to prevent nosocomial infections, treatment of meningeal septicemia Elizabethella infection preferred vancomycin, sulfamethoxazole / trimethoprim, minocycline, rifampicin and enzyme-containing inhibitors.