2018—2020年重症监护病房医院感染病原菌分布及耐药情况分析  

Distribution of pathogenic bacteria causing nosocomial infection and drug-resistance in ICU from 2018 to 2020

作　　者：彭贵霞 张华根[1] 黄晓星 罗伟杰 彭升[2] Peng Guixia;Zhang Huagen;Huang Xiaoxing;Luo Weijie;Peng Sheng(Respiratory Intensive Care Unit,Meizhou People’s Hospital,Meizhou,Guangdong 514031,China;Intensive Care Unit,Southern Medical University Zhujiang Hospital,Guangzhou 510282,China)

机构地区：[1]梅州市人民医院呼吸重症监护科,广东梅州514031 [2]南方医科大学珠江医院重症监护科,广州510282

出　　处：《中华生物医学工程杂志》2021年第6期667-673,共7页Chinese Journal of Biomedical Engineering

基　　金：广东省中医药局科研项目(20211392)。

摘　　要：目的分析2018—2020年重症监护病房(ICU)医院感染病原菌分布及耐药情况。方法回顾性分析2018年1月至2020年6月梅州市人民医院ICU住院治疗患者87例的临床资料,包括外科重症监护病房(SICU)16例、心脏重症监护室(CICU)4例、急诊重症监护室(EICU)4例、综合性重症监护室(GICU)53例、神经外科重症监护病房(NSICU)9例、呼吸内科重症监护病房(RICU)1例。分析医院感染率、标本来源及病原菌分布、耐药菌检出情况。结果2018年、2019年、2020年ICU医院感染率分别为0.39%、0.44%、0.30%,总感染率为0.39%。87例ICU医院感染患者标本主要来源于痰标本(45.98%)、尿标本(24.14%)、血液标本(13.79%)。共检出87株病原菌,病原菌以大肠埃希菌比例最高(43.68%,38/87),其次为鲍曼不动杆菌(24.14%,21/87);SICU、GICU检出病原菌均以大肠埃希菌为主。87株病原菌均为耐药菌株,以ESBL阳性菌株检出率最高,其次为XDR广泛耐药菌株。SICU、CICU、GICU、NSICU均以ESBL阳性菌株检出率最高。检出的大肠埃希菌、肺炎克雷伯菌肺炎亚种菌株均为产ESBL阳性菌株,金黄色葡萄球菌均为MRSA阳性菌株;鲍曼不动杆菌中XDR广泛耐药菌株检出率最高,占71.43%(15/21),其次为MDR多重耐药菌株,占19.05%(4/21)。抗菌药物使用情况分析显示,哌拉西林他唑巴坦、头孢呋辛、哌拉西林舒巴坦分别在鲍曼不动杆菌、大肠埃希菌、肺炎克雷伯菌肺炎亚种感染中使用率较高,头孢噻肟舒巴坦钠、哌拉西林他唑巴坦在金黄色葡萄球菌感染中使用率较高,哌拉西林他唑巴坦、亚胺培南西司他丁、替考拉宁在铜绿假单胞菌感染中使用率较高。结论梅州市人民医院ICU医院感染病原菌总体以革兰阴性菌为主,耐药菌则以ESBL阳性菌株最常见。Objective To investigate the distribution of pathogenic bacteria causing nosocomial infection and drug-resistance in our intensive care unit(ICU)from 2018 to 2020.Methods Included in this study were clinical data from 87 patients hospitalized in ICU of Meizhou People’s Hospital between January 2018 and June 2020,comprising 16 cases from surgical intensive care unit(SICU),4 from cardiac intensive care unit(CICU),4 from emergency intensive care unit(EICU),53 from general intensive care unit(GICU),9 from neurosurgery intensive care unit(NSICU),and 1 from respiratory medical intensive care unit(RICU).The rate of nosocomial infections,source of specimens,distribution of pathogenic bacteria,and detection yield of drug-resistant bacteria were analyzed.Results From 2018 through 2020,the rates of nosocomial infections in ICUs of the hospital were 0.39%,0.44%,and 0.30%,respectively,corresponding to an overall infection rate of 0.39%.The sources of specimen from 87 ICU patients with nosocomial infection mainly included sputum(45.98%),urine(24.14%),and blood(13.79%).A total of 87 pathogen strains were identified,among which,Escherichia coli accounted for the highest proportion(43.68%,38/87),followed by Acinetobacter baumannii(24.14%,21/87).E.coli predominated in pathogens detected from SICU and GICU.All of 87 pathogen strains were drug-resistant,with ESBL-positive strains accounting for the highest detection yield,followed by extensively drug-resistant(XDR)strains.ESBL-positive strains contributed to the highest detection yield of drug-resistant bacteria from SICU,CICU,GICU,and NSICU.All isolated strains of E.coli and Klebsiella pneumoniae subsp.pneumoniae were ESBL-positive strains,and all of Staphylococcus aureus strains were MRSA-positive.In A.baumannii,XDR strains accounted for the highest detection yield of drug-resistance[71.43%(15/21)],followed by multi-drug resistant(MDR)strains[19.05%(4/21)].Analysis of antibacterial use showed that piperacillin-tazobactam,cefuroxime,piperacillin-sulbactam were administered freque

关 键 词：重症医学科 医院感染 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]