综合重症加强治疗病房医院感染的常见致病菌分析以及耐药性监测结果  

A survey on distribution and drug resistance of pathogens causing nosocomial infection in general intensive care unit

作　　者：刘海峰[1] 周柱江[1] 胡靖青[1] 黄妮娜[1] 陈文兆[1] 朱瑞秋[1] 卢剑海[1] 陈燕河[1] 麦家惠 苏用鹏[1] 

机构地区：[1]南方医科大学附属顺德区第一人民医院重症医学科,广东顺德528300

出　　处：《中国中西医结合急救杂志》2015年第4期382-385,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：广东省佛山市科技局立项课题（201108248）

摘　　要：目的调查综合重症加强治疗病房（ICU）医院感染常见致病菌分布及耐药性变化，为合理使用抗菌药物和医院感染的预防控制提供科学依据。方法分离2007年1月至2014年12月南方医科大学附属顺德区第一人民医院ICU住院患者的各类标本中557株致病菌，采用K—B纸片扩散法和最低抑菌浓度（MIC）法进行药敏试验，并按美国临床实验室标准化委员会／临床和实验室标准协会（NCCLS／CLSI）标准判定结果，分析ICU医院感染菌株分布特点及耐药性情况。结果ICU医院感染常见菌株主要来源于痰液标本（占68．8％），其次是尿液（占12．4％）和血液（占6．8％）。557株临床分离菌中共检出革兰阴性（G^-）杆菌377株、革兰阳性（G^＋）球菌103株和真菌77株，分别占67．7％、18．5％和13．8％。G^-杆菌中鲍曼不动杆菌（占34．5％）、肺炎克雷伯杆菌（占17．8％）、铜绿假单胞菌（占13．0％）排前3位。除碳青霉烯类药物外，鲍曼不动杆菌对其余抗菌药物耐药率均〉40％。G^＋球菌以金黄色葡萄球菌为主（占36．9％），对青霉素、庆大霉素、红霉素的耐药率均〉50％。真菌77株中白色念珠菌排第一位，占41．6％。结论ICU感染主要以呼吸道为主；病原菌主要以G^-杆菌为主；对抗菌药物耐药性严重，临床工作中应该加强抗菌药物的规范使用，避免耐药菌株的产生。Objective To investigate the distribution and drug resistance of pathogens in intensive care unit （ICU） so as to provide scientific basis for antibiotic adoption and the prevention and control of nosocomial infections. Methods The various specimens collected from the patients admitted into ICU in the First People＇s Hospital of Shnnde Affiliated to the South Medical University from January 2007 to December 2014 were used to isolate the pathogens that might cause nosocomial infections and retrospectively analyze their clinical distribution and drug resistance. Kirby-Bauer paper diffusion and minimal inhibitory concentration （MIC） methods were applied to test the drug sensitivity, and according to National Committee for Clinical Laboratory Standards/Clinical and Laboratory Standards Institute （NCCLS/CLSI） standard, the results were identified. Results The sputum was the major specimen source in ICU, accounting for 68.8%, followed by urine （12.4%） and blood （6.8%）. All together 557 pathogens in ICU causing nosocomial infections were isolated of which there were 377 gram-negative （G^-） bacilli （67.7%）, 103 gram-positive （G^＋） cocci （18.5%）, and 77 fungi （13.8%）. Among G- bacilli, the top three were Acinetobacter baumannii （34.5%）, Klebsiella pneumonia （17.8%）, and Pseudomonas aeruglnosa （13.0%）. Beside carbapenern, the drug resistance rates of Acinetobacter baumannii to other antibiotics were more than 40%. The main G^＋ coccus causing nosocomial infection was Saphylococcus aureus （36.9%） in ICU. The drug resistance rates of Saphylococcus aureus to penicillin, gentamicin and erythromycin were higher than 50%. In 77 fungus strains, Candida albicans was ranked the first, accounting for 41.6%. Conclusion The main infection site in ICU is primarily respiratory tract, the G- bacilli are the predominate pathogens, and the drug resistance to antibiotics found in this report is serious, so clinically, the antibiotics should be properly used to avoid the occurrence o

关 键 词：重症加强治疗病房 医院感染 抗菌药物 耐药性 

分 类 号：R978.12[医药卫生—药品]