216例神经科重症监护病房患者医院感染及病原菌分析  

Etiological analysis of 216 cases of hospital-acquired infections in neurology intensive care unit

作　　者：姜嘟嘟 柳毅刚 詹青 

机构地区：[1]上海同济医院神经科重症监护室,上海200065

出　　处：《中国感染与化疗杂志》2013年第1期35-39,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解神经科重症监护病房(NICU)患者合并医院感染的病原菌分布及细菌耐药性,为合理应用抗菌药物提供依据。方法对2008年1月1日—2011年12月31日收住NICU并发生医院感染的216例患者住院期间分离的病原菌检出构成比、药敏试验等进行回顾性分析。结果医院感染依次有肺炎107例次(其中呼吸机相关性肺炎39例次)、尿路感染100例次(其中导尿管相关性尿路感染91例次)、血流感染26例次(其中中心静脉导管相关性血流感染11例次)。经培养鉴定共分离出582株病原菌,其中革兰阴性杆菌占65.5%,革兰阳性球菌占24.9%,真菌占9.6%。临床分离的革兰阴性杆菌依次为肺炎克雷伯菌(25.2%)、铜绿假单胞菌(22.3%)、鲍曼不动杆菌(18.1%)、大肠埃希菌(17.3%)和奇异变形杆菌(4.5%);革兰阳性球菌依次为金葡菌(43.4%)、溶血葡萄球菌(17.2%)、屎肠球菌(8.3%)、表皮葡萄球菌(8.3%)和鹑鸡肠球菌(4.8%)。真菌以白念珠菌为主(66.1%)。大多数革兰阴性杆菌对碳青霉烯类抗生素、头孢哌酮-舒巴坦、哌拉西林-他唑巴坦有较高敏感性。鲍曼不动杆菌耐药情况严重,69株中含广泛耐药菌20株,占29.0%。除头孢哌酮-舒巴坦的敏感率达72.3%外,其余药物的敏感率均很低。革兰阳性球菌对万古霉素、利奈唑胺高度敏感。结论 NICU医院感染病种分布的特点以导管相关感染为主,包括呼吸机相关肺炎,导尿管留置及血管内留置导管相关感染等。病原菌以不发酵糖革兰阴性杆菌为多见,且鲍曼不动杆菌呈多重耐药。Objective To investigate microbiological etiology of hospital-acquired infections in Neurology ICU and their antibiot- ic resistance pattern to provide basis for rational antimicrobial therapy. Methods The pathogens of hospital acquired infections in 216 NICU patients and the results of susceptibility testing from January 1, 2008 to December 31, 2011 were analyzed retro- spectively. Results The top three infections were pneumonia （including 39 ventilator-associated pneumonia）, urinary tract in- fection （including 91 catheter-associated urinary tract infections）, and bloodstream infection （including 11 central venous cathe- ter-related bloodstream infections）. A total of 582 strains of pathogens were collected, of which gram negative bacilli, gram positive cocci and fungal pathogens accounted for 65.5%, 24.9% and 9.6%, respectively. The top five gram-negative rods were Klebsiella pneumoniae （25.2 %） , Pseudornonas aeruginosa （22.3 %） , Acinetobacter baumannii （ 18. 1 %） , Escherichia coli（ 17.3 % ） and Proteus rnirabilis （4.5 % ）. The top gram-positive pathogens were Staphylococcus a ureus （43.4% ）, Staph- ylococcus haemol ytieus （17. 2 % ） , Enterococcus f aeciumv （8.3%）, Staphylococcus e pidermidis （8.3%）, and Enterococcus gallinarurn （4.8%）. Candida albicans was the most frequently reported fungal pathogen. Most strains of gram negative rods were highly susceptible to carbapenems, cefoperazone-sulbactam and piperacillin-tazobactam, but resistant to aminoglycosidesand fluoroquinolones. The resistance of Acinetobacter baumannii was serious, including 29%（20/69） extensively drug resistant strains. The strains of Acinetobacter baurnan- nil were highly susceptible to only cefoperazone-sulbactam.Strains of gram positive cocci were highly susceptible to vancomycin and linezolid. Conclusions Most of the hospital infections in NICU are device-related infections, including ventilator associated pneumonia, catheter associated urinary tract infections, and central ven

关 键 词：神经科重症监护病房 病原菌 医院获得性感染 

分 类 号：R446.5[医药卫生—诊断学]