重症医学科患者血流感染细菌谱分析  

Analysis of Blood Stream Infections in Intensive Care Unit

作　　者：汪海源[1] 洪涛[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重症医学科,沈阳110004

出　　处：《中国医科大学学报》2016年第4期356-360,共5页Journal of China Medical University

摘　　要：目的分析重症医学科(ICU)患者血流感染(BSI)细菌谱及其时间分布特点,以便为临床抗生素的使用提供借鉴。方法根据是否置入中心静脉导管(CVC)将1 330例ICU患者分为CVC组及无CVC组,回顾性分析患者发生血流感染的比例、血流感染的细菌谱、构成比以及患者入住ICU不同时间段(第1周、第2周及2周以后)发生血流感染的细菌分布情况。结果 CVC组971例,血流感染96例(9.89%);无CVC组359例,血流感染12例(3.34%);总体血流感染率为8.12%。共分离出病原菌株157株,CVC组141株,无CVC组16株。感染细菌构成比革兰阴性杆菌、革兰阳性球菌和真菌分别为56.7%、32.5%和10.8%;前5位细菌分别为葡萄球菌(16.6%)、鲍曼不动杆菌(15.9%)、肠球菌(14.6%)、铜绿假单胞菌(10.2%)和克雷伯菌(10.2%)。从时间分布上看,无CVC组第1周、第2周血流感染革兰阴性杆菌分别为3例、4例,第2周以后革兰阳性球菌5例,而真菌则未检出;CVC组在第1周、第2周及2周后革兰阴性杆菌、革兰阳性球菌及真菌分别为第1周31例、24例、3例,第2周23例、12例、11例,2周后26例、8例、3例。革兰阴性杆菌、革兰阳性球菌及真菌所占比例第1周分别为53.4%、41.4%和5.2%,第2周分别为50%、26.1%和23.9%,2周以后分别为70.3%、21.6%和8.1%,第2周出现真菌血症的概率最高。结论入住ICU第1周、第2周患者血流感染以革兰阴性杆菌为主;2周后CVC组感染仍以革兰性阴性杆菌为主;无CVC组以革兰阳性球菌为主。真菌在CVC组中第2周出现可能性最高,无CVC组出现可能性极低;与CVC组比较,无CVC组血流感染率低,真菌血症发生率低。Objective To analyze blood stream infections （BSI） in ICU patients, to explore the bacterial spectrum characteristics and time distribu- tion, so as to provide a reference for the clinical use of antibiotics. Methods A retrospective analysis was carried out. A total of 1 330 patients admit- ted in our hospital intensive care unit （ICU） from January 2012 to March 2013 （ 15 months ） were selected for the study, the occurrence rate of blood stream infections, the bacteria spectrum of it and the bacteria spectrum distribution in different period of time （admitted in ICU for the first week, sec - ond week and later） were analyzed. The subjects were divided into 2 groups （CVC cases and non- CVC cases ）depended on CVC indwelling or not. Results There were 971 cases with central venous catheter （CVC）, the occurrence of bloodstream infection were 96 cases, the infection rate was 9.89%, including 359 non- CVC cases and 12 blood stream infection cases. The infection rate was 3.34%, and the total blood infection rate was 8.12%. A total of 157 strains of pathogen were isolated, among which 16 strains were isolated from non-CVC cases. Infection of gram-negative bacilli, grmn-positive cocci and fungi were 56.7%, 32.5% and 10.8%, respectively. Staphylococcus （ 16.6% ）, Bauman acinetobacter （ 15.9% ）, Enterocec- cus （14.6%）, Pseudomonas aemginosa （10.2%） and Klebsiella （10.2%） were the most common bacteria. For the distribution of time, in non-CVC cases gram-negative bacilli were more than other bacilli in the first and second week （3 vs 1,4 vs 1 ） in ICU, more gram-positive cocci （ 5 vs 2） were isolated after two weeks, no fungi were detected; in CVC cases, gram negative bacilli were in a dominant position all the time （the number of gram negative bacilli, gram positive bacteria and fungi were 31 cases, 24 cases and 3 cases in the first week respectively, 23 cases, 12 cases, 11 cas- es in the second week, 26 cases, 8 cases and 3 cases after the second week）, the proportion

关 键 词：重症医学科 血流感染 细菌 

分 类 号：R446.5[医药卫生—诊断学]