尿毒症患者医院感染及细菌药敏分析  

Nosocomial infections in uremic patients and analysis of bacterial drug susceptibility

作　　者：刘晓强[1] 覃颖丽 严海燕[1] 

机构地区：[1]中山大学孙逸仙纪念医院,广东广州510120 [2]中国南方航空公司航空卫生中心,广东广州510406

出　　处：《中华医院感染学杂志》2013年第13期3276-3278,共3页Chinese Journal of Nosocomiology

基　　金：广东省科技计划项目(2012B031800042)

摘　　要：目的了解尿毒症患者医院感染病原菌分布和耐药率,为控制感染提供依据。方法对中山大学孙逸仙纪念医院2008年1月-2011年12月407例尿毒症住院患者的临床资料进行回顾性分析。结果 407例尿毒症患者发生医院感染106例,感染率为26.0%,感染患者的住院天数、送检次数、治疗费用均高于未感染患者,两者差异有统计学意义(P<0.01);感染部位主要为呼吸系统49.6%和泌尿系统25.2%;共检出病原菌173株,其中革兰阴性菌79株,占45.7%,革兰阳性菌60株,占34.7株,真菌34株,占19.7%,病原菌排前3位的依次为铜绿假单胞菌、大肠埃希菌、溶血葡萄球菌,分别占13.3%、10.4%、9.8%;革兰阴性杆菌对哌拉西林/他唑巴坦、亚胺培南较敏感,对其他抗菌药物耐药率较高,革兰阳性球菌除对替考拉宁、万古霉素、利奈唑胺未发现耐药外,对其他抗菌药物均有不同程度耐药。结论尿毒症患者易发生医院感染,且对抗菌药物耐药情况较严重;临床上应加强病原菌监测培养及药敏分析,合理使用抗菌药物。OBJECTIVE To investigate the condition of nosocomial infections in uremic patients and the distribution and antibiotics resistance rates of the pathogens so as to control the infections.METHODS A retrospective analysis was performed for the clinical data of 407cases of uremic patients who were hospitalized in Sun Yat-Sen Memorial Hospital from Jan 2008to Dec 2011.RESULTS Of 407patients with uremia,the nosocomial infections occurred in 106cases and the nosocomial infection rate was 26.0%.The difference in the hospitalization duration,inspection frequency,or cost of treatment between the patients with infections and the patient without infections was statistically significant（P〈0.01）.The primary site of infection was the respiratory system,accounting for 49.6%,followed by the urinary system（25.2%）.Totally 173strains of pathogens were detected,including 79（45.7%）strains of gram-negative bacteria,60（34.7%）strains of gram-positive bacteria,and 34（19.7%）strains of fungi;the Pseudomonas aeruginosa,Escherichia coli and Staphylococcus haemolyticus were the top three species of pathogens,accounting for 13.3%,10.4%,and 9.8%,respectively.The gram-negative bacilli were highly sensitive to piperacillin/tazobactam and imipenem,and the drug resistance rates to other antibiotics were relatively high;the gram-positive cocci varied in the drug resistance except vancomycin,teicoplanin and linezolid which showed no drug resistance.CONCLUSION The uremic patients are prone to nosocomial infection and the antibiotics resistance is serious.It is necessary for the hospital to strengthen the monitoring and culture of pathogens,perform the drug susceptibility testing so as to reasonably use antibiotics.

关 键 词：尿毒症 医院感染 耐药性 

分 类 号：R378[医药卫生—病原生物学]