重症监护病房患者尿路感染的危险因素与病原菌分布及耐药性分析  

Risk factors,pathogens distribution and drug resistance of urinary tract infection in patients in ICU

作　　者：朱立强[1] 李庆华[2] 孙金旗[1] 胡溢博[1] 陈茂才[1] 冀恒涛[1] 

机构地区：[1]郑州大学第二附属医院检验科,河南郑州450000 [2]郑州大学生命科学院,河南郑州457000

出　　处：《中华医院感染学杂志》2017年第11期2457-2460,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨重症监护病房患者尿路感染的危险因素、病原菌分布及耐药性,为重症监护病房患者尿路感染的临床预防治疗实践提供参考依据。方法选取2014年1月-2015年12月医院收治的重症监护病房患者1 621例为研究对象,统计患者的尿路感染发生率,并对导致感染发生的相关因素、致病菌及药敏性进行调查研究。结果 1 621例重症监护病房患者中,发生尿路感染患者289例,尿路感染率为17.83%;年龄、住院时间、GCS评分、昏迷时间、尿路侵入性操作和感染史等因素是导致患者尿路感染的影响因素;289例尿路感染患者共检测出病原菌322株,其中革兰阴性菌199株占61.80%、革兰阳性菌111株占34.47%、真菌12株占3.73%,粪肠球菌和屎肠球菌分别检出54株和34株;54例粪肠球菌对替考拉宁、利奈唑胺和替加环素的耐药率较低;对喹奴普汀/达福普汀的耐药率较高;34例屎肠球菌对万古霉素、替考拉宁、利奈唑胺、替加环素等耐药率较低;对青霉素G、环丙沙星的耐药率较高。结论重症监护病房患者尿路感染情况较为严重,粪肠球菌和屎肠球菌是导致重症监护病房患者尿路感染的主要革兰阳性菌,临床实践中应针对病原菌的药敏试验结果给予患者针对性的治疗方案。OBJECTIVE To investigate risk factors,pathogens distribution aud drug resistance of urinary tract infection in patients in ICU,so as to provide references for clinical prevention and treatment of urinary tract infection in patients in ICU.METHODS A total of 1621 patients in ICU of our hospital from Jan.2014 to Dec.2015 were chosen as the research objects.The incidence of urinary tract infection was taken for statistical analysis,and the related factors,pathogens and susceptibility of the infection were investigated.RESULTS In the 1621 patients in ICU,289 cases were with urinary tract infection and the urinary tract infection rate was 17.83%.Age,hospitalization time,GCS score,coma duration,urinary tract invasive procedure,and infection history were factors affecting the urinary tract infection.Among the 289 cases of urinary tract infection,there were 322 strains of pathogens,among which gram negative bacteria,gram-positive bacteria and fungi were 199,111 and 12 strains,with the proportions of 61.80%,34.47% and 3.73%,respectively.There were 54 and 34 strains of Enterococcus faecalis and Enterococcus faecium detected.The resistant rates of 54 strains of E.faecalis to teicoplanin,linezolid and tigecycline were low,and the resistant rate to quinupristin/dalfopristin was higher.The resistant rates of 34 strains of E.faecium to vancomycin,teicoplanin,linezolid and tigecycline were low,and the resistant rates to penicillin G and ciprofloxacin were higher.CONCLUSION Urinary tract infection in patients in ICU is serious,and E.faecalis and E.faecium are the main gram positive pathogens causing urinary tract infection in patients in ICU.It should take targeted treatment according to the susceptibility results of pathogens in clinic.

关 键 词：粪肠球菌 屎肠球菌 重症监护病房 尿路感染 

分 类 号：R378[医药卫生—病原生物学]