| 碳青霉烯类耐药肠杆菌科资料循证医学评价 |
| Alternative Title | Evidence-Based Analysis of Carbapenem-resistant Enterobacteriaceae
|
| 罗晓慧 |
| Thesis Advisor | 金凤玲
|
| 2015-05-22
|
| Degree Grantor | 兰州大学
|
| Place of Conferral | 兰州
|
| Degree Name | 硕士
|
| Keyword | 碳青霉烯类抗菌药物耐药的肠杆菌科细菌
Meta分析
耐药机制
检测方法
感染现状
|
| Abstract | 目的：现使用Meta 分析的方法，通过查找收集相关课题的研究文献对我国碳青霉烯类抗菌药物耐药的肠杆菌科细菌（CRE）的耐药机制进行概括统计分析；探讨现有各类CRE检测方法的优缺点及灵敏度和特异度的可靠性；对国内医院外科系统感染现状进行循证医学评价，综合全面的了解我国CRE感染流行及相关疾病的检出控制状况。方法：计算机检索PubMed、wanFang Data、VIP、CNKI、The cochrane Library、EMbase及CBM数据库，将检索时限定为从1994年开始至2014年12月为止，筛选后进行统计及Meta 分析。结果：共纳入对CRE耐药机制研究相关文献37篇，共研究分析了我国各地区14个省累积为1081株CRE菌株。显示：菌种前三位是肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌；比较淮河以南和淮河以北的CRE的相关耐药基因显示：目前在我国出现的CRE菌株主要为产生碳青霉烯酶，以KPC酶为首；其次是外膜蛋白的数量减少或缺失伴由染色体或质粒介导持续产生高水平β-内酰胺酶。对有关CRE诊断方法研究，最终纳入文献16篇(中文10篇，英文6篇)。分析显示：（1）改良Hodge试验作为检测CRE菌株的初步筛选试验。（2）CHROMagar™ KPC检测培养皿法：合并特异度及敏感度均不高，但最大的优点为检测方法简便。(3)美罗培南和APBA（3-氨基苯硼酸）联合KPC表型检测: 该法操作简单，并提供了客观的判断标准，结果清晰易读，且经现有研究表明其检测KPC的灵敏度与特异度均为100%。国内综合医院感染现状研究的相关文献共纳入87篇。统计分析：综合医院院内感染占内外科室病患的百分比发现，外科体系感染患病机率稍高；月份以9-11月期间医院感染率较高；感染部位以呼吸道、泌尿道、血液为三大易感部位；医院感染检出致病菌种类及构成显示，G-杆菌仍占检出菌一半以上；真菌感染比率有逐年上升趋势。 |
| Other Abstract | Abstract
Objectives： By using the method of system analysis of Meta related to the evaluation of drug resistance mechanism of our country Enterobacteriaceae of carbapenem; reliability using the existing various detection methods of evidence-based medicine study on the principle of carbapenem resistant Enterobacteriaceae. The advantages and disadvantages of sensitivity and specificity; and evidence-based analysis of nosocomial infection in surgery department of National Hospital, comprehensive understanding of the epidemic and infection associated diseases in China of carbapenem resistant Enterobacteriaceae detection control status.
Methods: Using computer retrieval PubMed, wanFang Data, VIP, CNKI, The cochrane Library, EMbase and CBM database and setting the timelines which is starting from 1994 until December 2014, retrieving and finding the required documents. Formulating the correspond standard to exclude and include the literatures. after screening the literature, we started to input the datum, statistic them and do the Meta analysis.
Results：By retrieving and after exclusion and inclusion criteria screening, There are 37 articles which write about the Resistance mechanisms of Penicillium carbon alkene resistant enterobacteriaceae bacteria, including 14 provinces and 1081 strains of CRE in China. Results statistical analysis showed that: Klebsiella pneumoniae, e. coli, sewer e. coli are The most common bacteria。Compared to the south of huaihe river and north of the huaihe river found that：The main resistance mechanism is produce carbon alkene enzyme in China. most of the articles have record Genotype analysis found that：the CRE mainly produce KPC enzyme, The second is losing Outer membrane protein, At the same time with the high level expression of Beta lactamase. According to statistics, about 40% of south of huaihe river, 32% of north of huaihe river. Other resistance mechanisms, for enterobacteriaceae is uncommon and even rare, so no much research literature.
Screening for relevant literature which about Diagnosis method research of CRE,There are 16 articles(10 papers in Chinese,6 papers in english). From this system evaluation result shows that: （1）The modified Hodge test to test for the CRE strain as preliminary screening test is quite appropriate. （2）CHROMagar ™ KPC petri dish method: detection of the specific degree (0.90) and the combining sensitivity (0.84) are not too high, but its the biggest advantage for the detection o... |
| URL | 查看原文
|
| Language | 中文
|
| Document Type | 学位论文
|
| Identifier | https://ir.lzu.edu.cn/handle/262010/222664
|
| Collection | 学院待认领
|
| Affiliation | 临床医学院
|
Recommended Citation
GB/T 7714 |
罗晓慧. 碳青霉烯类耐药肠杆菌科资料循证医学评价[D]. 兰州. 兰州大学,2015.
|
Items in the repository are protected by copyright, with all rights reserved, unless otherwise indicated.
