重症监护室住院患者多重耐药定植菌调查与临床分析  

Clinical colonization of multidrug-resistant bacteria in an intensive care unit

作　　者：常洪美[1] 张丕[1] 柴建华[1] 黎宏[1] 戴忠红[1] 李建英[1] 晏东[1] 蒲奎江 马琳[1] 高翔荣[1] 凌冬[1] 陈玲[1] 陈开全[1] 

机构地区：[1]崇州市人民医院,四川崇州611230

出　　处：《中国感染控制杂志》2013年第6期439-441,共3页Chinese Journal of Infection Control

基　　金：成都市科技局基金(1299YB092SF-002)

摘　　要：目的了解某院重症监护室(ICU)患者多重耐药菌定植情况及临床特点。方法对2012年2月14日—3月13日入住该ICU的75例患者,经鼻前庭拭子和直肠拭子采集标本,进行多重耐药定植菌筛查。结果 75例住ICU患者中,27例(36.00%)标本分离出多重耐药定植菌。送检标本中,鼻拭子91份,检出2株耐甲氧西林金黄色葡萄球菌(MRSA);肛拭子91份,检出产超广谱β-内酰胺酶(ESBLs)大肠埃希菌22株,产ESBLs肺炎克雷伯菌1株,多重耐药鲍曼不动杆菌1株,多重耐药荧光假单胞菌1株。多重耐药菌定植阳性率,住院时间≥3 d者和<3 d者分别为47.37%、32.14%;年龄≥60岁和<60岁者分别为37.29%、31.25%;患感染性基础疾病者和非感染性基础疾病者分别为39.22%、29.17%。21株多重耐药定植菌分离自第1天采集的标本,其中19株是院外定植,1株为其他医院内定植,1株为本院内科定植;5株分离自第3天采集的标本,定植时间为入ICU后72 h内,在ICU定植;1株分离自第7天采集的标本,定植时间为入ICU72 h后,在ICU定植。结论该院ICU患者多重耐药菌定植率高,以年龄≥60岁、患感染性疾病的患者为主,应引起临床医生高度重视;应加强多重耐药菌的预防和控制工作,避免多重耐药菌感染在医院内暴发流行。ObjectiveTo investigate the colonization and clinical characteristics of multidrugresistant （MDR） bacteria isolated from intensive care unit （ICU） patients.MethodsNasal and rectal swabs of 75 patients admitted to an ICU from February 14, 2012 to March 13,2012 were screened by bacteriological surveillance.ResultsAmong 75 patients, 27 （36.00%） were detected multidrugresistant（MDR） strains;Ninetyone nasal swabs were detected 2 methicillinresistant Staphylococcus aureus （MRSA） isolates;91 rectal swabs were detected 22 isolates of extendedspectrum βlactamase（ESBL）producing Escherichia coli, 1 ESBLproducing Klebsiella pneumoniae isolate, 1 MDR Acinetobacter baumannii, and 1 MDR Pseudomonas fluorescens. Bacterial colonization rates were as follows： patients with length of hospital stay ≥3 days and 〈3 days was 47.37% and 32.14%, respectively, patients aged ≥60 years and 〈60 years was 37.29% and 31.25% respectively， patients with infectious underlying diseases and noninfectious underlying diseases was 39.22% and 29.17%，respectively. 21 MDR isolates were isolated from the specimens taken on the first day of admission,19 of which were communitycolonized bacteria, 1 was colonized at the other hospital, and 1 was colonized at the department of internal medicine in this hospital;5 isolates were isolated from specimens taken on the third day,and 1 isolate was isolated on the seventh day, all 6 isolates were colonized at ICU after 72 hours of admission.ConclusionColonization rate of MDR bacteria is high in patients in ICU, especially those aged ≥60 years and/or with infectious diseases, which should be paid attention by clinicians;surveillance should be intensified so as to avoid the outbreak of MDR bacterial infection in hospital.

关 键 词：重症监护室 抗药性 微生物 多重耐药 定植菌 医院感染 超广谱&beta -内酰胺酶 耐甲氧西林金黄色葡萄球菌 

分 类 号：R446.5[医药卫生—诊断学]