重症监护病房医院感染非发酵菌的临床调查  

Clinical Investigation of Nosocomial Infections Caused by Non-fermenting Bacteria in ICU

作　　者：石薇[1] 程君[1] 马泰[1] 孙婧[1] 王敏[1] 罗晓明[2] 王中新[2] 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病科,安徽合肥230022 [2]安徽医科大学第一附属医院ICU,安徽合肥230022

出　　处：《中华医院感染学杂志》2010年第20期3124-3126,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金项目(30772286)

摘　　要：目的对重症监护病房(ICU)患者医院感染非发酵菌的临床特征、相关危险因素及细菌耐药性进行分析,为ICU临床合理应用抗菌药物提供可靠依据。方法对2003年1月-2008年12月入住ICU确诊有非发酵菌感染的91例患者进行回顾性调查,采用χ2检验和多因素Logistic回归分析对复数菌感染、疾病转归危险因素,以及经验用药与多药耐药菌出现的相关性进行分析。结果从91例患者不同的感染部位共分离出150株非发酵菌,97株分离自痰标本;鲍氏不动杆菌比例最高(38.7%),对亚胺培南耐药率最低(22.4%),多种侵入性操作与复数菌感染和疾病转归有直接相关性;咪唑类抗真菌药与多药耐药的发生有密切关系(P=0.033)。结论鲍氏不动杆菌是引起ICU患者医院感染的主要非发酵菌之一,对多种抗菌药物存在高耐药率,应加强监测,减少不必要的侵入性操作,慎重经验用药,对于减少ICU医院感染有重要意义。OBJECTIVE To analyze the clinical characteristics,risk factors and bacterial resistance of the non-fermenting bacteria which caused the nosocomial infection of patients in ICU,so as to provide the reliable basis for the clinical rational use of antimicrobial agents in ICU.METHODS A retrospective investigation was carried out on 91 non-fermenting bacteria infected patients in ICU from Jan 2003 to Dec 2008.χ2 test and multivariate Logistic Regression analysis were used to analyse the risk factors for complex infections,the risk factors for disease prognosis,and the correlation analysis between the experimental use of usual medicine and multi-drug resistant bacteria.RESULTS A total of 150 non-fermenting bacteria were isolated from different infected sites.Of 91 patients,in which 97 were isolated from sputum specimens.The percentage of Acinetobacter baumannii（38.7%）was the highest,while the drug resistant rate to imipenem was the lowest（22.4%）.It was found that many invasive operations were directly related to the bacterial infection and disease prognosis（P0.05）.Imidazole antifungal agents and the occurrence of multi-drug resistance had a close relationship（P=0.033）.CONCLUSION Acinetobacter baumannii is the major non-fermenting bacteria which cause the nosocomial infection in ICU patients.The surveillance should be strengthened because of a variety of antimicrobial agents on the presence of high resistance rate.Reducing the unnecessary invasive operations and using usual medication carefully have great impact on reducing ICU nosocomial infections.

关 键 词：重症监护病房 非发酵菌 危险因素 耐药性 

分 类 号：R181.3[医药卫生—流行病学]