ICU 院内感染的病原菌分析及临床防治  

The Clinical Analysis and Treatment of Pathogenic Infection in ICU Department of Hospital

作　　者：苗丽霞[1] 何本让[1] 李树生[2] 杨光田[2] 

机构地区：[1]郧阳医学院附属东风医院急救中心,十堰442008 [2]华中科技大学同济医学院附属同济医院急诊科

出　　处：《临床急诊杂志》2005年第2期15-17,共3页Journal of Clinical Emergency

摘　　要：目的了解 ICU 医院感染的流行病学及细菌耐药性情况,为临床防治提供依据。方法对同济医院 ICU 病房2002年1月～2003年9月所有分离的细菌菌株、真菌菌株及细菌耐药性进行回顾性调查。结果医院内感染仍以革兰氏阴性(G^-)菌为主(60.3%),其次为真菌(25.4%),革兰氏阳性(G^+)菌(14.3%)。G^-菌以铜绿假单孢菌为主(占42.5%)。真菌以白色念珠菌为主(87.2%)。G^+菌以金黄色葡萄球菌(金葡菌)为主(68.2%),金葡菌中耐苯唑青霉素的金葡菌(MRSA)占87.4%,表皮葡萄球菌(表葡菌)中耐苯唑青霉素的表葡菌(MRSE)占62.6%。在细菌耐药方面,G^-菌对舒普深、头孢他啶及亚胺培南耐药率较低。MRSA 对万古霉素仍敏感,无一例耐药。结论 ICU 感染中仍以 G^-菌为主,但真菌及 G^+菌已逐渐成为重要致病菌,应受到重视。获得性感染菌谱的变迁及细菌耐药率升高,使临床经验性选择抗生素治疗医院感染更加困难,及时掌握病原菌及耐药性的最新动态,指导临床医生正确选用抗生素,意义重大。Objective:To evaluate the epidemiology and drug resistance of pathogenic microorganism which caused nosocomial in- fection in patients in ICU,and helped doctors to decide rational diagnosis and retreatment.Methods Retrospective analysis of the pathogens including bacteria,fungus isolated from the samples from the ICU of Tongji hospital between January 2002 to September 2003,and at the same time their drug susceptibility tests were done.Results The pathogens of nosocomial infection were mainly Gram-negative bacilli (60.3%),followed with fungus(25.4%)and Gram-positive bacilli(14.3%).Pseudomonas aerouginasa predominated in Gram-negative bacilli with 42.5% ,candida albicans predominated in fungus with 68.2%.In S.aureus the proportion of MRSA was 87.4%,and the propor- tion of MASE in S.epidermidis was 62.6%.Drug susceptibilily tests suggested that most Gram-negative bacilli were poorly sensitive to supus- en,ceftazidime andimipenem but MRSA was highly sensitive to Vancomycin.Conclusions Gram-negative bacilli predominated in the patho- gens of the nosocomial infection in ICU,but we must pay more attention that fungal infections are becoming more common.Changes in patho- gens and the rate of drug resistance make it difficult to choose antibiotics to retreat nosocomial infetoin by experience.Dynamic understanding the distribution of isolation and drug susceptibility test results of different pathogenic bacteria has significant importance in helping doctors to decide rational therapy.

关 键 词：ICU 医院感染 病原菌 抗生素 耐药性 防治 

分 类 号：R181.34[医药卫生—流行病学] R459.7[医药卫生—公共卫生与预防医学]