重症监护室多重耐药菌医院感染临床特点与耐药性分析  

Analysis of clinical characteristics and drug resistance of nosocomial infection with multi-drug resistant organisms in intensive care unit

作　　者：林佩贤[1] 黄宝添[2] 许斐斐[1] 林伟青[1] 

机构地区：[1]汕头大学医学院第二附属医院医院感染管理科,广东省汕头市515041 [2]汕头大学医学院附属肿瘤医院放疗科,广东省汕头市515000

出　　处：《国际流行病学传染病学杂志》2015年第4期228-231,共4页International Journal of Epidemiology and Infectious Disease

基　　金：广东省科技厅社会发展计划（20128031800216）

摘　　要：目的了解ICU中多重耐药菌（MDRO）所致医院感染的临床特点和耐药情况，为临床抗菌治疗、院内感染防控提供依据。方法以ICU医院感染患者为调查对象，按是否为MDRO感染者分为病例组（60例）和对照组（35例），比较两组的临床特点、病原菌耐药情况和疾病负担。结果95例医院感染患者共检出病原菌136株，其中60名患者检出MDRO菌株共94株。主要耐药菌株为鲍曼不动杆菌、铜绿假单胞菌和金黄色葡萄球菌，感染部位以肺部为主．共68株．占72．34％。鲍曼不动杆菌对抗菌药物普遍耐药，但对替加环素较敏感，耐药率为12．50％；铜绿假单胞菌对左氧氟沙星和亚胺培南耐药率较低，均为33．33％：金黄色葡萄球菌对呋喃妥因、利奈唑烷、万古霉素、替加环素、奎奴普丁／达福普汀、替考拉宁均敏感。病例组的急性生理与慢性健康评分（APACHEⅡ）及病死率分别为（23．05±8．45）分和25．00％，均明显高于对照组的（18．86±7．04）分和8．57％，差异有统计学意义（t=2．48，x2=3．88．P〈0．05）；同时，与对照组相比，病例组住院时间更长，住院费用也更高（在2．26、2．55，P〈0．05）。结论ICU医院感染的病原体以MDRO居多，对大部分抗菌药物耐药。MDRO感染可导致患者病情加重，预后更差．经济负担更重。Objective To explore the clinical feature and antibiotic resistance of nosocomial infection caused by multi-drug resistant organisms （MDRO） in intensive care unit （ICU）, and to provide reference for clinical treatment and prevention measure of hospital infection. Methods The nosocomial infection patients who stayed in ICU were investigated. According to whether infected by MDRO, the patients were divided into case group and control group. Clinical characteristics, antimicrobial resistance of pathogen, and burden of diseases were compared between two groups. Results. A total of 136 strains of pathogen were detected from 95 patients. There were 94 strains of MDRO isolated from 60 patients. The main types of MDRO were Aciuetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus. Pulmonary infection was the principal infection site [68 strains （72.34%）]. Acinetobacter baumannii strains were resistant to many antibiotics, but sensitive to glycylcycline, and the resistant rate was 12.50%. Pseudomonas aeruginosa strains were found low resistant rate to levofloxacin and imipenem, and the rate were both 33.33%. Staphylococcus aureus strains were sensitive to nitrofurantoin, linozelid, vancomycin, g｜ycylcycline, quinupristin/dalfopristin and teicoplanin. The APACHE Ⅱ score and mortality rate of case group were （23.05±8.45） and 25.00% respectively, and both higher than （18.86±7.04） and 8.57% of control group. Those differences had statistical significance （t=2.48,X2=3.88, P〈0.05）. Meanwhile, compared with control group, the hospitalization time of case group was longer, and cost was higher （X2=2.26, 2.55,P〈0.05）. Conclusions The pathogens caused hospital infection are MDROs mainly, and the bacteria resistant to most antibacterial agents. MDRO infection may lead to aggravation, worse prognosis and heavier financial burden.

关 键 词：抗药性 多药 重症监护室 医院感染 

分 类 号：R446.5[医药卫生—诊断学]