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目的了解神经内科患者医院感染病原菌分布情况,检测肺炎链球菌的耐药基因,为临床合理用药提供依据。方法收集本院神经内科住院患者创口无菌棉拭子及创口周围标本,进行肺炎链球菌的培养、分离及鉴定;采用K-B法分析肺炎链球菌的耐药性;采用PCR扩增法检测肺炎链球菌的耐药基因分布情况。结果共分离病原菌377株,主要感染类型为革兰阳性菌(占63.13%),其次为革兰阴性菌(占36.87%)。在238株革兰阳性菌中,肺炎链球菌、金黄色葡萄球菌、酿脓链球菌、屎肠球菌以及其他革兰阳性菌的分离率分别为23.87%、14.06%、10.08%、6.90%和8.22%;在139株革兰阴性菌中,肺炎克雷伯菌、鲍氏不动杆菌、阴沟肠杆菌、铜绿假单胞菌以及其他革兰阴性菌的分离率分别为11.94%、9.02%、6.10%、2.92%和6.90%;分析90株肺炎链球菌的耐药性,其对红霉素耐药率为100.00%,对青霉素、四环素、左氧氟沙星的耐药率分别为32.22%、74.44%、16.67%,对万古霉素耐药率为0。PCR检测肺炎链球菌耐药基因erm、tetM、mefA、gyrA和pbp2b基因大小分别为616、406、346、382和682bp。各耐药基因的检出率分别为62.86%、71.88%、30.77%、10.88%和28.91%。结论神经内科感染病原菌以革兰阳性菌为主,其中又以肺炎链球菌居多。肺炎链球菌的tetM基因和erm基因的检出率较高,治疗肺炎链球菌感染应首选万古霉素。
Objective To understand the distribution of nosocomial pathogenic bacteria in neurological patients and to detect the drug resistance genes of Streptococcus pneumoniae so as to provide basis for clinical rational drug use. Methods Inpatients in our department of neurology inpatients with sterile cotton swab wounds and wound specimens were cultured, isolated and identified Streptococcus pneumoniae; using KB method to analyze the drug resistance of Streptococcus pneumoniae; using PCR amplification to detect pneumonia chain Coccidiosis resistance gene distribution. Results A total of 377 pathogenic bacteria were isolated. The main infection types were Gram-positive bacteria (63.13%), followed by Gram-negative bacteria (36.87%). In 238 Gram-positive bacteria, the isolation rates of S. pneumoniae, S. aureus, S. pyogenes, E. faecium and other Gram-positive bacteria were 23.87%, 14.06%, 10.08%, 6.90% and 8.22 %. The isolates of Klebsiella pneumoniae, Acinetobacter baumannii, Enterobacter cloacae, Pseudomonas aeruginosa, Pseudomonas aeruginosa and other Gram-negative bacteria in 139 Gram-negative bacteria were 11.94%, 9.02%, 6.10 %, 2.92% and 6.90%. The drug resistance of 90 Streptococcus pneumoniae strains was analyzed. The resistance rate to erythromycin was 100.00%. The resistance rates to penicillin, tetracycline and levofloxacin were 32.22%, 74.44%, 16.67 %, Vancomycin resistance rate of 0. PCR detection of Streptococcus pneumoniae resistance genes erm, tetM, mefA, gyrA and pbp2b gene size were 616,406,346,382 and 682bp. The detection rates of various drug resistance genes were 62.86%, 71.88%, 30.77%, 10.88% and 28.91% respectively. Conclusion The main pathogens of neurological infection are Gram-positive bacteria, of which S. pneumoniae is predominant. Streptococcus pneumoniae tetM gene and erm gene detection rate is higher, the treatment of pneumococcal infection should be the preferred vancomycin.