我院ICU脑干出血患者医院感染病原菌分布及耐药性分析  

Distribution of Nosocomial Infection Pathogens and Analysis of Drug Resistance in ICU Patients with Brainstem Hemorrhage in Our Hospital

作　　者：黄伟丽[1] 周杰[2] 李奇峰[1] 隋忠国[3] 时萍[3] 

机构地区：[1]青岛大学附属医院医院感染管理部,山东青岛266062 [2]青岛大学附属医院预防保健科,山东青岛266062 [3]青岛大学附属医院药学部,山东青岛266062

出　　处：《中国药房》2017年第2期182-185,共4页China Pharmacy

基　　金：山东省医学领军人才培养基金资助项目(No.ts20110814)

摘　　要：目的:为临床合理使用抗菌药物提供参考。方法:收集2014年1月-2015年12月我院重症医学科(ICU)283例脑干出血患者的病原学资料,回顾性分析其医院感染病原菌的分布特征及耐药情况。结果:283例患者中,确诊为医院感染的患者共205例,感染率为72.44%;共送检临床标本765份,以痰液(60.00%)、血液(14.38%)和胆汁(9.54%)等标本为主;共检出病原菌765株,包括以肺炎克雷伯菌为主的革兰氏阴性菌496株(64.84%),以金黄色葡萄球菌为主的革兰氏阳性菌238株(31.11%)和以白色假丝酵母菌为主的真菌31株(4.05%);共检出产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌89株、产ESBLs大肠埃希菌23株、耐甲氧西林金黄色葡萄球菌87株。肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌和鲍曼不动杆菌对碳青霉烯类药物敏感(耐药率<5%);金黄色葡萄球菌、表皮葡萄球菌和产色葡萄球菌对常用抗菌药物的耐药率均较高,但对万古霉素敏感(耐药率均为0)。结论:我院ICU脑干出血患者医院感染的主要病原菌为革兰氏阴性菌,其耐药情况及产酶情况不容乐观;对主要病原菌敏感性较高的药物包括碳青霉烯类药物和万古霉素等。临床应加强监测病原菌的耐药特征,有针对性地选用抗菌药物。OBJECTIVE： To provide reference for rational drug use. METHODS： The etiological data of 283 patients with brainstem hemorrhage were collected from our hospital during Jan. 2014-Dec. 2015. The distribution characteristics and drug resistance of nosocomial infection pathogens were analyzed retrospectively. RESULTS ： Of 283 patients, 205 patients were diagnosed as nosocomial infection with infection rate of 72.44%. 765 clinical specimens were tested, mainly including sputum （60.00%）, blood （14.38%） , bile （9.54%） , etc. All of 765 pathogens were isolated, mainly including 496 strains of Gram-negative bacteria （64.84 % ） composed mainly by Klebsiella pneumoniae, 238 strains of Gram-positive bacteria（31.11% ） composed mainly by Staphylococcus aureus, 31 strains of fungus （4.05%） composed mainly by Candida albicans. There were 89 strains of ESBLs-producing K. pneumoniae, 23 strains of ESBLs-producing Escherichia coli and 87 strains of MRSA. K. pneumoniae, E. coli, Pseudomonas aeruginosa and Acinetobacter baumannii were sensitive to carbapenems （resistant rate〈5 % ）. S. aureus, Staphylococcus epidermidis and Staphylococcus chromogenes showed high resistant rate to commonly used antibiotics, but were sensitive to vancomycin （resistant rate was 0）. CONCLUSIONS： Main nosocomial infection pathogens of ICU patients with brainstem hemorrhage in our hospital are Gram-negative bacteria, and the situation of drug resistance and enzyme production are not optimistic. Main pathogens are sensitive to carbapenems and vancomycin, etc. More attention should be paid to drug resistance characteristics of pathogen monitoring, and antibiotics should be selected rationally.

关 键 词：重症医学科 脑干出血 医院感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学] R446.5[医药卫生—基础医学]