危重症患者尿路感染的病原菌谱和时间分布特点  

Bacterial spectrum characteristics and distribution of urinary tract infections in intensive care unit

作　　者：汪海源[1] 洪涛[2] 臧彬[1] 

机构地区：[1]中国医科大学附属盛京医院重症医学科,沈阳110004 [2]中国医科大学附属盛京医院疼痛病房,沈阳110004

出　　处：《中华泌尿外科杂志》2015年第5期380-383,共4页Chinese Journal of Urology

摘　　要：目的 分析重症医学科（intensive care unit,ICU）患者尿路感染的细菌构成及入住ICU不同时间段尿路感染细菌的变化情况.方法 回顾性分析2012年1月至2013年3月ICU收治的1 330例留置尿管患者的临床资料,男705例,女625例.年龄11～ 94岁,平均（55.4±19.2）岁.急性生理及慢性健康Ⅱ评分1～69分,平均（17.1±9.3）分.留置尿管时间1～28 d,平均23 d.使用无菌注射器收集留置尿管中的尿液行细菌培养,记录尿路感染的发生率、感染的细菌谱及其构成比,以及患者入住ICU第1、2、4周发生尿路感染的细菌构成情况.结果 本组1 330例中发生尿路感染36例（2.7％）,其中男性感染率为3.0％（21/705）,女性为2.4％（15/625）.共分离病原菌株49株,其中革兰阴性杆菌32株（65.3％）,革兰阳性球菌16株（32.7％）,真菌1株（2.0％）.占主导地位的细菌分别为屎肠球菌15株（30.6％）、大肠埃希菌11株（22.4％）、鲍曼不动杆菌5株（10.2％）、肺炎克雷伯菌（10.2％）.患者入住ICU第1、2、4周的尿路感染中,革兰阴性杆菌分别为8株（50.0％）、4株（57.1％）、20株（76.9％）,革兰阳性球菌分别为7株（43.8％）、3株（42.9％）、6株（23.1％）;真菌尿路感染仅出现在入住ICU第1周,为1株（6.3％）.结论 ICU尿路感染的病原菌以革兰阴性杆菌为主,真菌尿路感染发生较少.革兰阴性杆菌以大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌为主,革兰阳性球菌以屎肠球菌为主.患者入住ICU前2周革兰阴性杆菌与革兰阳性球菌构成比相近,2周以后革兰阴性杆菌构成比增加.Objective To investigate bacterial spectrum characteristics and distribution of urinary tract infections with different time phase in intensive care unit（ICU）.Methods From January 2012 to March 2013,the clinical data of 1330 cases in ICU,treated with urinary catheter indwelling,was retrospectively reviewed.Among them,705 cases were male and 625 cases were female.Their age ranged from 11 to 94 years old,mean （55.4 ± 19.2）years old.Acute physiology and chronic health scores （APACHE Ⅱ） were 1 to 69,mean 17.1 ±9.3.Duration of catheter indwelling ranged from 1 to 28 days,mean 23 days.The urine was collect through catheter via sterile syringe for bacterial culture.The incidence of urinary tract infection,bacterial infection spectrum,composition ratio and bacteria distribution in 1,2 and 4 weeks after admission were recorded.Results Total urinary tract infection cases were 36（2.7%）.There were 15 urinary tract infection cases in 625 famale cases（2.4%）,There were 21 cases in 705 male cases （3.0%）.49 pathogens were obtained,including 32 gram-negative bacilli （65.3%）,17 gram-positive cocci （32.7%） and 1 fungus 2.0%.Enterococcus faecium （30.6%）,E.coli （22.4%）,Acinetobacter baumannii（10.2%）,and Klebsiella pneumoniae （10.2%） were the predominant species.According to hospitalized time,the bacteria spectrum distribution showed Gram negative bacilli were 50.0% （8 pathogens）,57.1% （4 pathogens）,76.9% （20 pathogens） and Gram positive bacteria were 43.8% （7 pathogens）,42.9% （3 pathogens）,23.1% （6 pathogens） in the differet observed time point,respectively.A fungus was only observed in the first week after admission 6.3%.Concluusions Gram-negative bacilli were predominant bacterial of urinary tract infections in ICU patients.The incidence of fungus infection was low.E.coli,Acinetobacter baumannii and Klebsiella pneumoniae were the predominant species in Gramnegative bacilli.And Enterococcus faecium was the predominant specie in gram-positive cocci.It was simi

关 键 词：重症医学科 尿路感染 细菌 

分 类 号：R446.5[医药卫生—诊断学]