ICU住院患者多药耐药菌感染病原特征分析  

Etiological characteristics of multidrug-resistant bacterial infections in patients in ICUs

作　　者：刘文慧[1] 闫利明[2] 贾芳[1] LIU Wen-hui;YAN Li-ming;JIA Fang(Hetao College,City of Bayannur,Inner Mongolia,China 015000;Bayannur Hospital)

机构地区：[1]河套学院教务处,内蒙古彦淖尔市015000 [2]巴彦淖尔市医院

出　　处：《中国病原生物学杂志》2019年第9期1072-1075,共4页Journal of Pathogen Biology

摘　　要：目的探究ICU住院患者多药耐药菌感染病原特征,为患者临床治疗及耐药性发展控制提供指导。方法收集ICU住院患者临床资料,采用全自动细菌鉴定仪鉴定患者感染病原菌类型。培养多药耐药鲍曼不动杆菌,采用PCR扩增检测菌株的外排泵基因。结果1 608例监测患者中,感染数为173例,感染率为10.76%。ICU住院患者主要分布在RICU、综合ICU、SICU、神经ICU、PICU、EICU、NICU、CCU,感染率分别为23.03%、17.79%、15.77%、12.30%、6.01%、4.27%、1.90%和1.87%。多药耐药菌在患者的呼吸道、泌尿道、胃肠道、血液、皮肤软组织类、表浅切口、血管相关部位的感染率分别为34.02%、12.79%、3.38%、2.26%、1.92%、0.98%和0.97%。多药耐药菌在患者的痰液、血液、体液、脓液、尿液、其他标本的感染率分别为32.90%、3.74%、3.40%、2.69%、2.84%和7.83%。173例感染患者种共检出多药耐药菌180株。多药耐药菌类型为鲍曼不动杆菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌、及其他菌株,构成比分别为46.67%、13.33%、7.22%、17.78%、11.67%和3.33%。外排泵基因类型为adeA+adeB、adeB+adeC、adeA+adeB+adeC、mdfA+adeB+adeC、qacE△1+adeA+adeC、mdfA+qacE△1+adeB+adeC的多药耐药鲍曼不动杆菌检出率分别为2.38%、4.76%、44.05%、26.19%、13.10%和9.52%。结论多药耐药菌感染的ICU住院患者主要分布于呼吸重症监护病房,主要检出部位为呼吸道,痰液是主要标本来源,多药耐药鲍曼不动杆菌是主要病原菌类型。多药耐药鲍曼不动杆菌中外排泵基因分布广泛,可能导致多药耐药性发生,临床应给予重视。Objectives To investigate the etiological characteristics of multidrug-resistant bacterial infections in patients in ICUs in order to guide the clinical treatment of infections and to control the development of drug resistance.Methods Clinical data on patients in ICUs were collected,and the types of pathogenic bacteria were identified by an automated microbial identification system.Multidrug-resistant Acinetobacter baumannii was cultured,and the efflux pump genes of the strain were detected via amplification with PCR.Results Of 1,608 monitored patients,173 developed an infection,for a rate of infection of 10.76%.Infected patients in ICUs were mainly found in the RICU(23.03%),an integrated ICU(17.79%),the SICU(15.77%),Neurology ICU(12.30%),the PICU(6.01%),the EICU(4.27%),the NICU(1.90%)and the CCU(1.87%).A multidrug-resistant bacterial infection was mainly found in the respiratory tract(34.02%),the urinary tract(12.79%),the gastrointestinal tract(3.38%),blood(2.26%),skin and soft tissue(1.92%),a superficial surgical wound(0.98%),and blood vessels(0.97%).A multidrug-resistant bacterial infection was mainly detected in sputum(32.90%),blood(3.74%),bodily fluids(3.40%),pus(2.69%),urine(2.84%),or other specimens(7.83%).The strains of multidrug-resistant bacteria detected were A.baumannii(46.67%),Klebsiella pneumoniae(13.33%),Staphylococcus aureus(7.22%),Pseudomonas aeruginosa(17.78%),Escherichia coli(11.67%),and other strains(3.33%).The efflux pump genotype of multidrug-resistant A.baumannii was adeA+adeB(2.38%),adeB+adeC(4.76%),adeA+adeB+adeC(44.05%),mdfA+adeB+adeC(26.19%),qacE△1+adeA+adeC(13.10%),and mdfA+qacE△1+adeB+adeC(9.52%).Conclusion Patients in an ICU with a multidrug-resistant bacterial infection were mainly found in the respiratory ICU,and bacteria were mainly detected in the respiratory tract.Bacteria were mainly found in sputum specimens,and multidrug-resistant A.baumannii was the main pathogenic bacterium.Multidrug-resistant A.baumannii has a wide array of efflux pump genes that may lead to multidrug

关 键 词：ICU住院患者 多药耐药菌 鲍曼不动杆菌 外排泵基因 

分 类 号：R378[医药卫生—病原生物学]