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目的探讨人苍白杆菌引起重症患者医院获得性感染的危险因素、产AmpC酶情况及耐药现状,为有效预防和治疗该菌感染提供科学依据。方法回顾性调查2011年1月-2016年8月重症医学科患者的临床资料,常规方法分离鉴定细菌,改良三维试验进行产AmpC酶检测,K-B纸片扩散法进行药敏试验,利用WHONET 5.6软件分析处理药敏试验结果。结果人苍白杆菌引起重症患者感染的主要危险因素有中央静脉插管、手术、机械通气等,该菌主要来自血液标本,产AmpC酶为70.3%,对含酶抑制剂、青霉素类、一代~三代头孢类、单环β-内酰胺类抗菌药物均有很强的耐药性,耐药率均>90.0%,对四代头孢类、复方磺胺类、氨基糖苷类、喹诺酮类、碳青酶烯类和四环素类等抗菌药物保持较低的耐药率,耐药率均<20.0%。结论侵入性诊疗是引起重症患者感染人苍白杆菌的主要危险因素,该菌主要引起血流感染,产AmpC酶率高,对β-内酰胺酶类抗菌药物高度耐药,治疗该菌感染首选氨基糖苷类、喹诺酮类、碳青酶烯类和四环素类等抗菌药物。
Objective To investigate the risk factors of Nosocomial Infection caused by Corynebacterium parvum in severe cases, the status of AmpC enzyme production and drug resistance status in order to provide a scientific basis for effective prevention and treatment of the infection. Methods The clinical data of patients from January 2011 to August 2016 were retrospectively analyzed. Bacteria were isolated and identified by routine methods. AmpC enzyme assay was performed with modified three-dimensional test. Susceptibility test was carried out with KB disk diffusion method. WHONET 5.6 software Analysis and treatment of drug susceptibility test results. Results The main risk factors of C. anthracis infection in critically ill patients were central venous catheterization, surgery, mechanical ventilation, etc. The bacteria mainly came from blood samples, producing 70.3% of AmpCases. The enzyme inhibitors, penicillins, Cephalosporins, monocyclic β-lactam antibiotics have strong resistance, resistance rates were> 90.0%, the fourth generation of cephalosporins, sulfamethoxazole compound, aminoglycosides, quinolones, carbapenem Antibacterials such as tetracyclines and tetracyclines maintained low rates of resistance, with drug resistance rates <20.0%. Conclusions Invaded diagnosis and treatment are the major risk factors for infection of Corynebacterium parvum in critically ill patients. The bacteria mainly cause bloodstream infection, high rate of producing AmpC enzyme and high resistance to β-lactamase antibiotics, Glycosides, quinolones, carbapenems and tetracyclines and other antibacterials.