重症监护病房侵入性治疗相关医院感染的病原分布特征  

Pathogenic characteristics of nosocomial infection associated with invasive operation in intensive care units

作　　者：朱薇[1] 项小燕[1] 陈立姣[1] 张烨[1] 卢琪 钦晓英[1] Zhu Wei;Xiang Xiaoyan;Chen Lijiao;Zhang Ye;Lu Qi;Qin Xiaoying(Zhejiang Provincial People's Hospital,People's Hospital of Hangzhou Medical College,Hangzhou 310014,China)

机构地区：[1]浙江省人民医院,杭州医学院附属人民医院,310014

出　　处：《国际流行病学传染病学杂志》2020年第5期469-472,共4页International Journal of Epidemiology and Infectious Disease

基　　金：浙江省医药卫生科技计划(2019ZH017)。

摘　　要：目的了解重症监护病房(ICU)侵入治疗患者发生医院感染的发生率及病原分布特征。方法收集2017—2019年浙江省人民医院ICU发生侵入治疗相关医院感染的185例患者的临床资料、病原体检测和药敏结果,分析患者院内感染情况以及相关病原体分布特征。结果中心静脉导管感染(CVCI)千日感染率为0.09‰,呼吸机相关性肺炎(VAP)和尿管相关泌尿系感染(CAUTI)分别为0.79‰和0.33‰。185例患者共分离到186株病原菌,其中CVCI和VAP患者以革兰阴性菌感染为主。肺炎克雷伯菌(KP)、鲍曼不动杆菌(AB)和铜绿假单胞菌(PA)在CVCI分别占37.21%、13.95%和6.98%,在VAP中分别占29.03%、32.26%和9.68%;CAUTI的优势菌株真菌占50.62%,均为热带念珠菌感染。KP、AB和PA多重耐药率分别为32.61%、72.22%和47.06%。念珠菌对两性霉素B敏感,但对氟康唑、伊曲康唑和伏立康唑的耐药率超过44%。结论浙江省人民医院ICU侵入治疗相关医院感染的发生率较低,分离的部分病菌有多重耐药现象。Objective To investigate the incidence of nosocomial infections associated with invasive operations in intensive care units(ICU)and the distribution of pathogens.Methods Clinical data,pathogen detection and drug sensitivity of 185 patients with nosocomial infections after invasive operation in ICU of Zhejiang Provincial People’s Hospital from January 2017 to December 2019 were retrospectively collected.The incidence of nosocomial infection and related pathogens were analyzed.Results The incidence rates of central venous catheter infection(CVCI),ventilator associated pneumonia(VAP)and catheter associated urinary tract infections(CAUTI)were 0.09‰,0.79‰and 0.33‰,respectively.A total of 186 strains were isolated from 185 patients,among whom cases with CVCI and VAP were mainly infected by gram-negative bacteria.K.pneumoniae(KP),A.baumannii(AB)and P.aeruginosa(PA)isolates accounted for 37.21%,13.95%and 6.98%in CVCI,while accounted for 29.03%,32.26%and 9.68%in VAP,respectively.Fungal predominance was found in 50.62%of CAUTI patients,and all of them were infected by C.tropicalis.The multiple drug resistance rates of KP,AB and PA were 32.61%,72.22%and 47.06%,respectively.Candida was sensitive to amphotericin B,but had the resistance rates of above 44%to fluconazole,itraconazole and voriconazole.Conclusions The incidence of nosocomial infections associated with invasive operations in ICU of Zhejiang Provincial People’s Hospital is relatively low,and some isolated bacteria show multiple drug resistance.

关 键 词：感染 重症监护 耐药性 

分 类 号：R446.5[医药卫生—诊断学]