论文部分内容阅读
目的了解重症监护室(ICU)患者医院感染的主要致病菌分布特点及耐药性情况,为临床合理应用抗菌药物提供依据。方法对2015年海盐县人民医院ICU住院患者的痰液、血液、伤口分泌物、尿液、粪便及胸腹水等标本进行病原菌鉴定与药敏试验,分析主要致病菌分布情况及耐药性。结果 3 887份送检标本共分离病原菌1 917株,其中1 562株来源于下呼吸道感染(81.48%)。革兰阴性菌1 455株(75.90%),分离株数前3位依次是肺炎克雷伯菌(29.96%)、铜绿假单胞菌(20.82%)和鲍曼不动杆菌(13.36%)。肺炎克雷伯菌对大部分抗菌药物均耐药,仅对头孢哌酮/舒巴坦、阿米卡星、替加环素敏感;铜绿假单胞菌对氨苄西林、阿莫西林/克拉维酸、头孢唑啉、头孢曲松、头孢西丁及呋喃妥因等耐药率均>90%;鲍曼不动杆菌对阿米卡星、替加环素敏感,对其他抗菌药物耐药率均>30%。革兰阳性菌214株(11.16%),以屎肠球菌(24.77%)和金黄色葡萄球菌(17.30%)为主,屎肠球菌对氨苄西林、青霉素、环丙沙星、左氧氟沙星和莫西沙星耐药率均>90%,分离的革兰阳性菌对万古霉素均无耐药性。真菌248株(12.94%),以白色念珠菌(50.81%)和热带假丝酵母菌(35.49%)居多,这两种真菌对5-氟胞嘧啶、两性霉素B敏感。结论 ICU感染多发生在下呼吸道,病原菌以革兰阴性菌为主,耐药情况较为严重,应加强ICU耐药监测并合理使用抗菌药物。
Objective To understand the distribution characteristics and drug resistance of nosocomial infections in intensive care unit (ICU) patients, and to provide a basis for clinical rational use of antimicrobial agents. Methods The sputum, blood, wound secretions, urine, feces, pleural and hydrothorax of hospitalized patients in ICU of Haiyan People’s Hospital in 2015 were tested for pathogen identification and drug susceptibility test. The distribution of main pathogenic bacteria and drug resistance were analyzed. Results A total of 1 917 pathogens were isolated from 3 887 samples, of which 1 562 were from lower respiratory tract infection (81.48%). There were 1 455 Gram-negative bacteria (75.90%). The top three isolates were Klebsiella pneumoniae (29.96%), Pseudomonas aeruginosa (20.82%) and Acinetobacter baumannii (13.36%). Klebsiella pneumoniae was resistant to most of the antibacterial drugs and was only sensitive to cefoperazone / sulbactam, amikacin and tigecycline; Pseudomonas aeruginosa was sensitive to ampicillin, amoxicillin / clavulanate Acine, cefazolin, ceftriaxone, cefoxitin and nitrofurantoin resistance rates were> 90%; Acinetobacter baumannii sensitive to amikacin, tigecycline, resistance to other antibiotics were> 30%. 214 strains of Gram-positive bacteria (11.16%) were Enterococcus faecium (24.77%) and Staphylococcus aureus (17.30%), and Enterococcus faecium was the most effective against Ampicillin, Penicillin, Ciprofloxacin, Levofloxacin and Moxifloxacin Resistance rates were> 90%, isolated Gram-positive bacteria were not resistant to vancomycin. 248 fungi (12.94%) were mostly Candida albicans (50.81%) and Candida tropicalis (35.49%), both of which were sensitive to 5-fluorocytosine and amphotericin B. Conclusion ICU infection mostly occurs in the lower respiratory tract. Gram-negative bacteria are the main pathogens in the ICU. The drug resistance is more serious. ICU drug resistance monitoring should be strengthened and antimicrobial agents should be used rationally.