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فراوانی نسبی آنزیم متالوبتالاکتاماز در سویه‌های سودوموناس ائروژینوزای جدا شده از نمونه‌های بالینی در شهر یزد به روش E Test

این فایل در 110 صفحه فایل word قابل ویرایش می باشد.

چکیده

مقدمه و هدف: متالوبتالاکتامازها (MBL) آنزیم‌هایی هستند که توسط باسیل‌های گرم منفی غیر تخمیری مانند سودوموناس آئروژینوزا تولید شده و این سویه‌ها را نسبت به کارباپنم مقاوم می‌سازد در نتیجه سودوموناس‌های حامل ژنهای متالوبتالاکتاماز یک تهدید کلینیکی جدی بشمار می‌آیند. با توجه به اینکه مقاومت در گونه باکتریایی سودوموناس آئروژینوزا به واسطه داشتن متالوبتالاکتامازها در برابر آنتی بیوتیک‌ها رو به افزایش بوده و در کشورها، مناطق و حتی بیمارستان‌های مختلف شیوع آن‌ها متفاوت می‌باشد بر آن شدیم تا شیوع این آنزیم را در نمونه‌های جمع آوری شده از بیمارستان‌های آموزشی یزد با استفاده از روش E Test بررسی کنیم.

فهرست مطالب

عنوان                                          صفحه

فصل اول: مقدمه و مروري بر مطالعات مشابه 1

1-1- خانواده پسود و موناداسه آ 2

1-2- تاریخچه P. aeruginosa 3

1-2-1- خصوصیات مورفولوژیک P. aeruginosa 5

1-2-2- خصوصیات رشد 5

1-2-3- هوازی‌های اجباریObligate aerobes 5

1-2-4- مشخصات کشت 6

1-2-5- مواد آلی مورد نیاز 7

1-2-6- محیط‌های کشت 8

1-2-7- پیگمان 9

1-2-8- شاخص‌های بیماریزایی در P. aeruginosa 11

1-2-8-1- پیلی(Pili) 11

1-2-8-2- آلژینات (Alginate) 12

1-2-8-3- اندوتوکسین 12

1-2-8-4- پروتئاز‌های خارج سلولی 13

1-2-8-5- همولیزین‌ها 15

1-2-8-6- فسفولیپاز ‍C 15

1-2-8-7- رامنولیپیدها 15

1-2-9- توکسین‌های خارج سلولی 16

1-2-9-1- اگزوتوکسینA 16

1-2-9-2- اگزوآنزیم S 16

1-2-10- لوکوسیدین با وزن ملکولی بالا 17

1-2-11- سیدروفورها 17

1-2-12- لیپاز 17

1-2-13- سیتوتوکسین 18

1-2-14- پایوسیانین       18

1-2-15- سیستم ترشحی نوع III 18

1-2-16- اپیدمیولوژی 19

1-2-17- بیماریهای ناشی از P. aeruginosa 20

1-2-17-1- باکتریمی 20

1-2-17-2- عفونت‌های گوش 20

1-2-17-3- عفونت‌های چشم 21

1-2-17-4- عفونت‌های مجرای تنفسی 21

1-2-17-5- عفونت‌های استخوان و مفصل 22

1-2-17-6- عفونت‌های سیستم عصبی مرکزی 22

1-2-17-7- عفونت‌های دستگاه گوارش 22

1-2-17-8- عفونت‌های پوست و بافت نرم 23

1-2-17-9- عفونت‌های دستگاه ادارای 24

1-2-17-10- باکتریمی 24

1-2-17-11- عفونتهای استخوان و مفصل 24

1-2-17-12- عفونت‌های سیستم عصبی مرکزی 24

1-2-17-13- اندوکاردیت عفونی 25

1-2-17-14- عفونت‌های مجرای تنفسی 25

1-2-17-15- عفونت پوست و بافت‌های نرم 26

1-2-17-16- عفونت‌های ادراری 26

1-2-18- متالوبتالاکتاماز 27

1-2-19- شيوع مقاومت متالوبتالاکتامازها 27

1-2-20- انواع  تيپ‌های متالوبتالاکتاماز 28

1-2-21- The Imipenemase(IMP) Type 28

1-2-22- The Veronese Imipenemase (VIM) Type 28

1-2-23- New Delhi Metalo β-lactamase-1 (NDM-1) Type 28

1-2-24-  ديگر تيپ‌های متالوبتالاکتاماز 29

1-2-24-1- روش‌های تشخيص متالوبتالاکتاماز 29

1-2-24-2- سنجس حساسيت) آنتی بيوگرام) 29

1-2-24-3- روش E.Test به وسيله نوار    MBL 30

مروری بر مطالعات گذشته 31

فصل دوم: مواد و روش‌ها 34

2-1 بیان مسئله و اهمیت موضوع 35

2-2- اهداف 36

2-2-1- اهداف اصلي طرح 36

2-2-2- اهداف ويژه طرح 36

2-3- سؤالات و فرضيات 36

2-4- نوع و روش مطالعه 37

2-5- روش کار 37

2-5-1- انواع محیط کشت 37

2-5-2- مکانکی آگار(Mac Conkey agar) 37

2-5-3- محیط کشت  SIM 38

2-5-4- روش آماده سازی معرف کواکس جهت تست اندول 39

2-5-5- محیط کشت OF 39

2-5-6- محیط کشت TSI 39

2-5-7- محیط سيمون سيترات 40

2-5-8- محیط مایع( ( MR-VP 40

2-5-9- طرز تهیه معرف VP 41

2-5-10- طرز تهیه معرف MR 41

2-5-11- تست اکسیداز 41

2-6- روش اجرای کار 42

2-6-1- جمع آوری نمونه‌ها 42

2-6-2- تعیین آنزیم متالوبتالاکتاماز 43

2-6-3- آنالیز آماری 44

2-6-4- محدودیت و مشکلات اجرایی طرح 44

2-7- جدول متغیرها 45

فصل سوم: يافته‌ها 46

3-1- نتایج 47

فصل چهارم: بحث، نتیجه گیری و پیشنهادات 69

4-1- بحث 70

4-2- نتیجه گیری 75

4-3- پیشنهادات 75

Abstract 76

فهرست مراجع 77

ضميمه: پرسشنامه 84

 

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