急诊重症监护病房病原学调查及临床分析  

Etiological investigation and clinical analysis of infectious diseases in emergency intensive care unit

作　　者：赵雪[1] 于沛涛[2] 王弋[1] 徐芝君[1] 顾清[1] 裘力锋[1] 

机构地区：[1]杭州市第一人民医院急诊科,310003 [2]北京大学医学部基础医学院

出　　处：《北京医学》2013年第3期178-181,共4页Beijing Medical Journal

摘　　要：目的总结急诊重症监护病房(emergency intensive care unit,EICU)感染因素、感染病原学分布,分析药物敏感性。方法回顾性分析2009年7月至2012年6月205例EICU感染病例的感染部位、感染因素、病原菌分布及对抗菌药物的敏感性。结果 EICU患者感染部位以下呼吸道最多,占57.6%。发生感染者多为高龄、住院时间长、伴有基础病及侵入性操作者。EICU感染病原菌以革兰阴性菌为主,占72.0%,革兰阳性菌占19.9%,真菌占8.2%。大肠埃希菌对头孢他啶、头孢吡肟、碳青霉烯类、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、阿米卡星的敏感率﹥75.0%;铜绿假单胞菌仅对头孢他啶、碳青霉烯类、头孢哌酮/舒巴坦敏感,其敏感率﹥75.0%;鲍曼不动杆菌仅对碳青霉烯类、头孢哌酮/舒巴坦敏感,其敏感率﹥75.0%;肺炎克雷伯菌对头孢他啶、头孢吡肟、碳青霉烯类、哌拉西林/他唑巴坦的敏感率﹥75.0%;肠球菌和金黄色葡萄球菌对糖肽类抗菌药物的敏感率为100.0%。结论 EICU患者高龄多伴有基础病、接受侵入性操作多、抗菌药物联合应用多,均是造成EICU感染的因素,常见病原菌多为耐药菌,应结合药敏结果合理选用抗菌药物。Objective To analyze infectious factors and pathogenic distribution, investigate drug sensitivity in e- mergency intensive care unit （EICU）. Methods Infection site, infectious factors, pathogenic distribution and drug sensi- tivity were retrospectively analyzed in 205 cases of EICU infection from July, 2009 to June, 2012. Results The lower res- piratory tract infection occurred most frequently in EICU patients （57.6%）. Most risk factors were old age, long-term hospi- talization, underlying diseases and invasive operations. The EICU infection was mainly caused by gram-negative bacteria, accounting for 72.0%, with gram-positive bacteria （19.9%）and fungi （8.1%）. The sensitivities of Eschenckia coli to cef- tazidime, cefepime, carbon carbapenem, piperacillin / tazobactam, cefoperazone / sulbactam and amikacin were above 75.0%. The sensitivities of Pseudomonas aeruginosa were above 75.0% only to ceftazidime, carbon carbapenem, cef- operazone/sulbactam. The sensitivities of Acinetobacter baumannff were above 75.0% only to carbon carbapenem and cef- operazone/sulbactam. The sensitivities of Klebsiella pneumoniae to ceftazidime, cefepime, carbon carbapenem and piperacillin/tazobactam were above 75.0%. The sensitivities of Enterococci and Staphylococcus aureus to glycopeptide an- tibiotics were 100.0%. Conclusion Most patients in EICU are old aged, complicated with underlying diseases, invasive operations and combined use of antibiotics, which are all infectious factors in EICU. Common pathogens are drug-resistant. It should be better to chose antibiotics according to susceptibility results.

关 键 词：急诊重症监护病房 感染 病原菌 敏感率 

分 类 号：R446.5[医药卫生—诊断学]