急诊科重症患者医院感染的病原学研究  

The etiology study of nosocomial infection in critically ill patients in emergency department

作　　者：陈毓[1] 楼炳恒[1] CHEN Yu;LOU Bingheng(Emergency Department,Quzhou City People＇s Hospital in Zhejiang Province,Quzhou 324000,China)

机构地区：[1]浙江省衢州市人民医院急诊科,浙江衢州324000

出　　处：《中国现代医生》2018年第31期87-90,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2017KY699)

摘　　要：目的探讨急诊科重症患者医院感染的病原学特点,为防治急诊科重症患者医院感染提供指导。方法以2015年1月10日～2017年12月23日我院500例急诊科重症患者为观察对象,对500例急诊科重症患者的临床资料进行回顾性分析,研究急诊科重症患者医院感染的病原学特点。结果 56例患者发生院内感染,以呼吸道感染、泌尿道感染、血液感染、腹腔感染、胸腔感染、手术切口感染较常见,导致感染的主要危险因素为使用呼吸机;共分离出201株病原菌,以革兰阴性菌、革兰阳性球菌、真菌、支原体较常见,所占比分别为60.20%、21.39%、9.95%、8.46%,且革兰阴性菌的所占比相比其他病原菌明显更高(P<0.05);病原菌总体排名前五位分别为铜绿假单胞菌(22.39%)、鲍曼不动杆菌(13.43%)、金黄色葡萄球菌(11.94%)、肺炎克雷伯菌(10.45%)、大肠埃希菌(6.47%)。革兰阴性菌多对氨曲南、亚胺培南、环丙沙星、头孢曲松、左氧氟沙星、丁胺卡那的耐药性较高,革兰阳性球菌对万古霉素、替考拉宁无耐药性,但对环丙沙星、左氧氟沙星、克林霉素、青霉素、红霉素的耐药性较强。结论急诊科重症患者医院感染的病原菌以革兰阴性菌为主,耐药性较普遍,为保证抗感染效果,应结合患者的药敏试验结果合理为其选择对应抗菌药物。Objective To explore the etiological characteristics of nosocomial infections in critically ill patients, to provide guidance for preventing and treating nosocomial infections in critically ill patients. Methods 500 critically ill patients in emergency department of our hospital from January 10, 2015 to December 23, 2017 were observed. The clinical data of those patients were retrospectively analyzed to investigate the pathogens of nosocomial infection in critically ill patients. Results Nosocomial infection occurred in 56 patients. Respiratory tract infections, urinary tract infections, blood infections, intra-abdominal infections, thoracic infections, and surgical wound infections were more common than other kinds of infections. The main risk factor for infection was the use of ventilators. A total of 201 strains of pathogenic bacteria were isolated. Gram-negative bacilli, gram-positive cocci, fungi, and mycoplasma were more common, accounting for 60.20%, 21.39%, 9.95%, and 8.46%, respectively, and the proportion of gram-negative bacilli was significantly higher than other pathogens（P〈0.05）. The top five pathogens were Pseudomonas aeruginosa（22.39%）, Acinetobacter baumannii （13.43%）, Staphylococcus aureus （11.94%）, and Klebsiella pneumoniae （10.45%）. E.coli （6.47%）.Gram-negative bacilli had high resistance to aztreonam, imipenem, ciprofloxacin, ceftriaxone,levofloxacin, and amikacin. Gram-positive cocci had no drug resistance to vancomycin, teicoplanin, but had strong resistance to ciprofloxacin,levofloxacin, clindamycin, penicillin, erythromycin. Conclusion The pathogens of nosocomial infections in critically ill patients in emergency departments were mainly gram-negative bacilli, and their drug resistance was more common. To ensure the anti-infective effect, the corresponding antimicrobial agents should be selected reasonably according to the patient＇s drug sensitivity test results.

关 键 词：急诊科 重症 医院感染 病原学 特点 

分 类 号：R446.5[医药卫生—诊断学]