同质化管理的两个综合ICU患者痰标本病原体构成及耐药性比较  

Comparison of pathogen composition and drug resistance of bacteria strains in sputum culture between two ICU wards under homogeneous management

作　　者：徐子琴 林建萍 张雪良 XU Ziqin;LIN Jianping;ZHANG Xueliang(Department of Critical Care Medicine,Wenzhou People's Hospital(the Third Affiliated Hospital of Shanghai University),Wenzhou 325006,China;不详)

机构地区：[1]温州市人民医院(上海大学附属第三医院)重症医学科,325006 [2]温州市人民医院(上海大学附属第三医院)微生物实验室,325006 [3]温州市人民医院(上海大学附属第三医院)全科医学科,325006

出　　处：《浙江医学》2022年第10期1078-1082,共5页Zhejiang Medical Journal

基　　金：温州市公益性科技基金资助项目(Y20170741)。

摘　　要：目的比较同质化管理的两个综合ICU患者痰标本病原体构成及耐药性,为医院感染控制策略的制订提供参考。方法选取2018年1月1日至2019年12月31日温州市人民医院娄桥院区(L组)综合ICU(2017年11月开始投入使用,以单间病房为主)收治的719例患者和同期信河院区(X组)综合ICU(投入使用>15年,以非单间病房为主)收治的417例患者为研究对象,比较两组患者痰标本病原体构成及耐药性。结果L组、X组患者痰标本中分离出菌株分别为1485、3692株。X组分离出革兰阴性菌的比例明显高于L组(86.48%比66.60%),分离出革兰阳性菌、真菌的比例均低于L组(1.41%、12.11%比4.98%、28.42%),差异均有统计学意义(均P<0.05)。与L组比较,X组鲍曼不动杆菌对替卡西林克拉维酸、氨苄西林舒巴坦、头孢他啶、头孢吡肟、头孢噻肟、头孢曲松、亚胺培南、美罗培南、左旋氧氟沙星、环丙沙星耐药率均较高(均P<0.05),铜绿假单胞菌对哌拉西林、头孢吡肟、头孢哌酮舒巴坦、亚胺培南、妥布霉素、庆大霉素、阿米卡星、左旋氧氟沙星、环丙沙星耐药率均较高(均P<0.05),肺炎克雷伯菌对哌拉西林他唑巴坦、氨苄西林舒巴坦、头孢他啶、头孢吡肟、头孢哌酮舒巴坦、头孢唑林、头孢曲松、头孢替坦、氨曲南、妥布霉素、庆大霉素、阿米卡星、左旋氧氟沙星、环丙沙星耐药率均较高(均P<0.05),金黄色葡萄球菌对头孢西丁、庆大霉素、四环素、红霉素、左旋氧氟沙星、环丙沙星、莫西沙星、利福平耐药率均较高(均P<0.05)。结论同质化管理的同院两个综合ICU病原体构成及耐药性存在差异,采用单间病房的ICU病原体耐药率较低。Objective To compare the pathogen composition and drug resistance of bacteria stains detected in sputum culture between two ICU wards in Wenzhou People's Hospital under the homogeneous management.Methods From January 2018 to December 2019,719 and 417 patients were admitted to the ICU wards in Luqiao campus(group L)and Xinhe campus(group X)of Wenzhou People's Hospital,respectively.The ICUs of two campuses were under the homogeneous management,while the ICU in Luqiao campus was equipped mainly with single-bed wards and that in Xinhe campus(operated>15 years)mainly with multi-bed wards.The pathogen composition and drug resistance of sputum specimens were compared between the two groups.Results A total of 1485 and 3692 bacterial strains were isolated from sputum samples of patients in L group and X group,respectively.The proportion of gram-negative bacteria strains isolated from group X was significantly higher than that from group L(86.48%vs.66.60%),and the proportion of gram-positive bacteria strains and fungi isolated from group X was significantly lower than that from group L(1.41%,12.11%vs.4.98%,28.42%,both P<0.05).Compared with group L,the drug resistance rates of acinetobacter baumannii isolats to ticacillin clavulanate,ampicillin,sulbactam,ceftazidime,cefepime,cefotaxime,ceftriaxone,imipenem,meropenem,levofloxacin and ciprofloxacinin of group X was significantly higher(P<0.05),and the drug resistance rates of pseudomonas aeruginosa to piperacillin,cefepime,cefoperazone sul bactam,imipenem,tobramycin,gentamicin,amikacin,levofloxacin and ciprofloxacin were significantly higher(P<0.05).The drug resistance rates of Klebsiella pneumoniae to piperacillin tazobactam,ampicillin sulbactam,ceftazidine,cefepime,cefoperazone sulbactam,cefazolin,ceftriaxone,ceftetan,amtronam,tobramycin,gentamicin,amikacin,levofloxacin and ciprofloxacin of group X were higher(P<0.05),and staphylococcus aureus stains in group X had higher drug resistance rates to cefoxitin,gentamicin,tetracycline,erythromycin,levofloxacin,ciprofloxacin,moxi

关 键 词：重症医学科 同质化管理 痰培养 病原体 耐药性 

分 类 号：R446.5[医药卫生—诊断学]