成人心血管外科重症监护病房医院感染情况的临床研究  

Nosocomial infection in adult cardiac surgery intensive care unit

作　　者：曹芳芳[1] 张海涛[1] 张永辉[1] CAO Fang-fang;ZHANG Hai-tao;ZHANG Yong-hui(State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,CAMS and PUMC,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院外科SICU,心血管疾病国家重点实验室,北京100037

出　　处：《中国分子心脏病学杂志》2018年第5期2609-2611,共3页Molecular Cardiology of China

摘　　要：目的探讨近年心血管外科重症监护病房医院感染的病原菌分布、药物敏感情况,为临床提供更好的诊疗措施。方法对医院心血管外科38696例术后患者进行回顾性分析。结果 2013～2017年1236例患者术后在发生感染,感染总发生率3.19%,共分离出致病菌1840株,包括革兰阴性杆菌1516株(82.4%),前5位是铜绿假单胞菌、肺炎克雷伯菌、阴沟肠杆菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌;革兰阳性球菌209株(11.4%),前4位是表皮葡萄球菌、粪肠球菌、金黄色葡萄球菌、溶血葡萄球菌;真菌115株(6.2%),白色念珠菌为主。革兰阴性菌对亚胺培南耐药率较低,阳性球菌对抗菌药物耐药较重,但对万古霉素、替加环素、利奈唑胺耐药性低,以真菌耐药率相对较低。结论心血管外科术后医院感染主要病原菌常为多药耐药菌和条件致病菌,且耐药趋势增加,临床仍需有效预防医院感染、明确诊断及合理用药。Objectives To investigate the distribution of nosocomial infection pathogens and their drug resistance variation in cardiac surgery intensive care units. Methods Totally 38696 patients who underwent cardiac operation were reviewed retrospectively. Results Nosocomial infections occurred in 1236 cases(3.19%) from 2013 to 2017 in our hospital. From 1840 strains isolated,Gram-negative bacilli were 1516(82.4%), Gram-positive cocci were 209(11.4%), fungi were 115(6.2%). Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter cloacae,Acinetobacter baumannii,Stenotrophomonas maltophilia Aeromonas were the predominant bacilli. Staphylococcus epidermidis,Enterococcus faecalis, Staphylococcus aureus, Staphylococcus haemolyticus were the predominant cocci, and Candida albicans was the first fungi.The results of susceptibility test suggested that the resistance rate of the Gram-negative bacilli to imipenem was low. Gram-positive cocci were with high prevalence of multiple antibiotic resistance except vancomycin, tigecycline and linezolid. Fungi had a low drug resistance. Conclusion The main pathogenic bacteria in cardiac surgery ICU are multidrug-resistant and conditional. Their antimicrobial agent resistance is more and more serious. We still have to prevent hospital infections, optimize diagnosis and application of antibiotics.

关 键 词：心脏外科 重症监护病房 医院感染 耐药性 

分 类 号：R446.5[医药卫生—诊断学]