利沃夫医院院内呼吸道感染细菌种类谱及耐药情况分析

O. Korniychuk, R. Shykula, Yurii Khorkavyi, Y. Konechnyi
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引用次数: 0

摘要

介绍。卫生保健相关感染(HAIs)是卫生保健系统中一个紧迫的问题。呼吸道感染(RTI)是第二常见的HAIs。院内肺炎主要由细菌引起,其发展的决定性因素之一是微生物因子的性质和毒力水平。早期院内肺炎发生在上呼吸道微生物群感染呼吸道时。晚期院内感染肺炎是由院内感染的微生物菌株引起的,其特点是对抗生素和消毒剂具有多药耐药性,毒力高,包括铜绿假单胞菌、不动杆菌、肠杆菌科、MRSA。不幸的是,在乌克兰,对HAIs的结构和流行以及病原体的抗菌素耐药性的研究非常少。研究的目的。因此,本研究调查了呼吸道感染主要病原体的种类谱和耐药性。材料和方法。对利沃夫市4家医院医院内呼吸道感染的微生物因素进行分析,对205例确诊为呼吸道感染的重症监护患者(36.6%)进行检查。使用Microsoft Excel 2010程序的标准软件包对结果进行统计分析。微生物学诊断是按照美国微生物学会第12版《细菌学和病毒学》和《临床微生物学指南》的现行规定进行的。微生物诊断在利沃夫国立医科大学微生物学系的研究实验室进行。结果。RTI病原菌的种类分布表明,在14个不同分类群的代表菌群中,革兰氏阳性菌群占优势,但每革兰氏阴性菌群的播种数量占70.17%。在HAIs的分离因子中,耐多药(MDR)占62.8%。3株为泛耐药菌株:2 - P. putida和1 - P. aeruginosa。革兰氏阳性菌群中以肠球菌(Enterococcus spp)最为常见,以粪肠球菌(E. faecalis)和粪肠球菌(E. faecium)为主。在革兰氏阳性菌群的临床材料中最常检测到粪肠杆菌。分离的粪肠球菌对青霉素(包括恶西林)、头孢菌素、氟喹诺酮类药物、红霉素和阿奇霉素、克林霉素具有明显耐药性,对万古霉素和利奈唑胺保持敏感性。铜绿假单胞菌对粘菌素有绝对敏感性。在其他抗生素中,最有效的是碳青霉烯类亚胺培南(57.5%)和美洛奈姆(55.0%)。只有37.5%的培养物对妥布霉素和替吉西林敏感,替吉西林是受保护的头孢菌素类抗生素磺胺酮的抑制剂。葡萄球菌属是除葡萄球菌外的肺炎病原体。球菌无性系种群。金黄色葡萄球菌;haemolyticus,葡萄球菌。lugdunensis。此外,仅检出1株耐甲氧西林葡萄球菌。重症监护病房患者的大多数RTI病例(57.4%)发生在气管切开术或插管后48小时内。结论。根据微生物学诊断结果,已经确定与医疗护理相关的医院性肺炎的主要病因是机会微生物——铜绿假单胞菌和肠球菌。62.8%的菌株为耐多药。此外,医院微生物菌株抗生素耐药性监测结果显示其在利沃夫不同机构的差异,并与医院环境完全相关。因此,只有更广泛地利用微生物学研究成果,持续监测重症监护病房患者的微生物状况,以及热情好客(医院病原体的分布和性质),才能优化医院源性肺炎的抗菌治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Species Spectrum of Bacterial Factors of Nosocomial Respiratory Infections in Hospitals of Lviv and the Prevalence of Antimicrobial Resistance Among Them
Introduction. Healthcare-associated infections (HAIs) are a pressing problem in the health care system. Respiratory tract infections (RTI) are the second most common group of HAIs. One of the determining factors in the development of nosocomial pneumonia, which is predominantly bacterial in origin, is the properties and level of virulence of microbial factors. Early nosocomial pneumonia occurs when the upper respiratory tract microbiota infects the respiratory tract. Late nosocomial pneumonia is caused by nosocomial strains of microorganisms, characterized by multidrug resistance to antibiotics and disinfectants high levels of virulence, which include P. aeruginosa, Acinetobacter spp., Enterobacteriaceae family, MRSA. Unfortunately, in Ukraine, the structure and prevalence of HAIs and the antimicrobial resistance of pathogens are extremely poorly studied. The aim of the study. Therefore, the study investigates the species spectrum and antimicrobial resistance of the main causative agents of respiratory tract infections. Materials and methods. A study of microbial factors of nosocomial respiratory tract infections in 4 hospitals in Lviv. 205 patients of intensive care units diagnosed with RTI (36.6 %) were examined. Statistical analysis of the results was performed using the standard package of the program “Microsoft Excel 2010”. Microbiological diagnostics were performed following current regulations in the specialty “Bacteriology and Virology” and “Guidelines for Clinical Microbiology” of the 12th revision of the American Association for Microbiology. Microbiological diagnostics is performed in the research laboratory of the Department of Microbiology of Danylo Halytsky Lviv National Medical University. Results. The species profile of the detected pathogens of RTI indicates that among 14 representatives of different taxa, the gram-positive microbiota predominates, but the quantitative level of seeding per gram-negative microbiota accounts for 70.17 %. Among the isolates – factors of HAIs, multidrug-resistant (MDR) share accounted for 62.8 %. 3 strains are classified as pan drug resistant (PDR): 2 – P. putida and 1 – P. aeruginosa. Of the gram-positive microbiota, Enterococcus spp., represented mainly by E. faecalis and E. faecium, was most often detected in clinical material. E. faecalis was most often detected in the clinical material of the gram-positive microbiota. E. faecalis isolates were characterized by pronounced resistance to penicillins (including oxacillin), cephalosporins, fluoroquinolones, erythromycin and azithromycin, clindamycin with preserved sensitivity to vancomycin and linezolid. Pseudomonas aeruginosa isolates showed absolute sensitivity to colistin. Among other antibiotics, the most effective in terms of the number of sensitive strains were carbapenems – imipenem (57.5 %) and meronem (55.0 %). Only 37.5 % of the cultures were sensitive to tobramycin and tegicillin, an inhibitor of the protected cephalosporin antibiotic, sulfperazone. The genus Staphylococcus was among the causative agents of pneumonia other than Staph. aureus subsp. aureus, will Staph. haemolyticus, Staph. lugdunensis. Moreover, only one strain of methicillin-resistant Staphylococcus was detected. Most cases of RTI (57.4%) of patients in intensive care units occurred within 48 hours after the installation of a tracheostomy or intubation tube. Conclusions. According to the results of microbiological diagnostics, it has been established that the main etiological factors of nosocomial pneumonia associated with medical care are opportunistic microorganisms – Pseudomonas aeruginosa and enterococci. 62.8 % of strains were MDR. Furthermore, the results of monitoring the antibiotic resistance of hospital strains of microorganisms show their differences in different institutions of Lviv and the connection exclusively with the hospital environment. Therefore, optimization of antimicrobial treatment of nosocomial pneumonia is possible only based on the broader use of microbiological research results, constant monitoring of the microbiological status of patients in intensive care units, hospitality (distribution and properties of pathogens in hospitals).
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