重症监护病房患者腹腔感染病原菌谱分析  

Pathogen spectrum of intra-abdominal infection in patients in intensive care unit

作　　者：汪海源[1] 吴兴茂[1] 臧彬[1] 

机构地区：[1]中国医科大学附属盛京医院,辽宁沈阳110004

出　　处：《中国感染控制杂志》2015年第10期681-684,共4页Chinese Journal of Infection Control

基　　金：辽宁省科学技术计划项目(201102293)

摘　　要：目的分析重症监护病房（ICU）患者腹腔感染病原菌谱分布。方法回顾性分析2012年1月—2013年3月某院ICU收治的1 330例患者中腹腔感染及分离病原菌情况。结果 283例患者出现腹腔感染,感染发病率为21.28%;133例（47.00%）患者检出病原菌186株,其中革兰阴性杆菌128株（68.82%）,革兰阳性球菌53株（28.49%）,真菌5株（2.69%）。主要革兰阴性杆菌为大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌,主要革兰阳性球菌为屎肠球菌、金黄色葡萄球菌和粪肠球菌。入住ICU≤2、3-7、8-14、〉14 d分别检出病原菌131株（70.43%）、24株（12.90%）、19株（10.22%）、12株（6.45%）;其中入住ICU≤48 h主要为大肠埃希菌（51株）、屎肠球菌（21株）,入住ICU〉48 h以鲍曼不动杆菌（18株）为主。病原菌主要检出于肠道、肝胆系统部位病变术后,分别占53.23%、24.19%。39例患者（29.32%）检出2种及以上病原菌,其中29例患者检出2种病原菌。结论腹腔感染病原菌以肠道及肝胆系统疾病术后检出较多,多种病原菌混合感染情况多见,且以革兰阴性杆菌为主。入住ICU48 h内腹腔感染以大肠埃希菌及屎肠球菌为主,48 h后以条件致病菌为主。Objective To analyze pathogen spectrum of intra-abdominal infection in patients in an intensive care unit（ICU）.Methods Intra-abdominal infections and pathogens of 1 330 patients who admitted to ICU from January 2012 to March2013 were analyzed retrospectively.Results 283 patients developed intra-abdominal infection,incidence of infection was 21.28%;133（47.00%）patients were detected 186 isolates of pathogens,the proportion of gram-negative bacilli,gram-positive cocci,and fungi were 68.82%（n=128）,28.49%（n= 53）,and 2.69%（n=5）respectively.The major gram-negative bacilli were Escherichia coli,Acinetobacter baumannii,and Klebsiella pneumoniae,the major gram-positive cocci were Enterococcus faecium,Staphylococcus aureus,and Enterococcus faecalis.The detection rates of pathogens after patients stayed in ICU for≤2,3-7,8-14,and〉14 days were 70.43%（n=131）,12.90%（n=24）,10.22%（n=19）,and 6.45%（n=12）respectively;Escherichia coli（n=51）and Enterococcus faecium（n=21）were the main pathogens when patients stayed in ICU for≤48 hours,Acinetobacter baumannii was the main pathogen when patients stayed in ICU for〉48 hours.Most intra-abdominal infection occurred after intestinal tract（53.23%）and hepatobiliary system operation（24.19%）.39（29.32%）patients isolated at least two kinds of pathogens,29 of whom isolated 2 kinds of pathogens.Conclusion Most pathogens of intra-abdominal infection in ICU patients are detected following intestinal tract and hepatobiliary operation,and mixed pathogens are common,predominantly gram-negative bacilli.Escherichia coli and Enterococcus faeciumare the main pathogens when patients stayed in ICU for≤48 hours,opportunistic pathogens are the main pathogens when patients stay in ICU for〉48 hours.

关 键 词：重症监护病房 腹腔感染 细菌谱 病原菌 社区感染 医院感染 

分 类 号：R459.7[医药卫生—急诊医学]