重症监护病房连续6年革兰阳性菌感染的调查分析  

An investigation of Gram-positive bacteria infection in an intensive care unit during 6 years

作　　者：王敏[1] 孙婧[1] 石薇[1] 马泰[1] 程君[1] 罗晓明[2] 王中新[3] 叶英[1] 李家斌[1] 

机构地区：[1]安徽医科大学第一附属医院感染科,合肥230022 [2]安徽医科大学第一附属医院ICU,合肥230022 [3]安徽医科大学第一附属医院检验科,合肥230022

出　　处：《中国危重病急救医学》2010年第8期451-454,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金资助项目（30772286）

摘　　要：目的 对本院重症监护病房（ICU）革兰阳性（G＋）菌感染患者危险因素、临床分离菌株的分布及其耐药性进行回顾性调查,为临床预防及诊治G＋菌感染提供参考.方法 以回顾性调查方法对2003年1月至2008年12月入住ICU,且有明确G＋菌感染的83例患者临床资料进行统计分析.结果 从83例患者的标本中分离出的125株G^＋菌,以葡萄球菌为主（63.2%,79/125）;疾病转归与手术（χ^2=9.107,P=0.003）、插胃管（χ^2=4.053,P=0.044）、并发症的出现（χ^25.908,P=0.015）及免疫抑制剂的应用（χ^2=5.761,P=0.016）有关;复数菌感染与手术（χ^2=8.847,P=0.003）及气管切开（χ^2=10.445,P=0.001）有关.体外药敏结果显示G＋菌呈多重耐药,但所有G＋菌均对万古霉素敏感,耐药率均为0.结论 葡萄球菌是ICU内G＋菌感染中最常见的致病菌;应加强ICU细菌耐药性监测,根据药敏结果合理选用抗菌药物;针对ICU内G＋菌的耐药及危险因素,采取相应的措施是预防控制感染、降低病死率的关键.Objective To retrospectively investigate the risk factors, distribution, antibiotic resistance of infection with Gram-positive （G＋） bacteria in an intensive care unit （ICU）, so as to provide the reference for clinical prevention and treatment. Methods A retrospective analysis of clinical data of 83 patients with G＋ bacteria infection in ICU from January 2003 to December 2008 was done. Results Of the 125 strains of G＋ bacteria from 83 patients, Staphylococcus was the main organism （63.2%, 79/125）. The prognosis of the patient was related with surgical operation （χ^2=9.107, P=0.003）, gastric intubation （χ^2=4.053, P=0.044）, complication （χ^2=5.908, P=0.015） and the use of immunosuppressant （χ^2=5.761, P=0.016）. Multi-bacterial infection was related with surgery （χ^2 =8.847, P=0.003） and tracheostomy （χ^2=10.445, P=0.001）. The antibiotic susceptibility test in vitro showed that G＋ bacteria displayed multi-resistance to antibiotics, but all of G^＋ bacteria were sensitive to vancomycin （resistance rate was 0）. Conclusion Staphylococcus was the most common pathogen of G＋ bacterial infection in ICU. Further surveillance of bacterial resistance is warranted in ICU, and antimicrobial drugs should be used according to the result of susceptibility test. Taking account of the antibiotic resistance and risk factors of G^＋ bacteria infection in ICU, the infection could be controlled and the death rate could be cut down when appropriate measures are taken.

关 键 词：重症监护病房 革兰阳性菌 危险因素 耐药 

分 类 号：R446.5[医药卫生—诊断学]