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目的评估重症监护病房(ICU)导管相关性血流感染的病原菌分布及耐药情况,为临床诊治提供依据。方法对414例ICU内疑似导管相关性菌血症(CRBSI)患者导管尖及配套外周静脉血液标本进行细菌培养、生化鉴定及药敏检测并分析结果。结果确诊为CRBSI阳性标本60例,分离病原菌60株,革兰阳性菌占20.00%(12/60)、革兰阴性菌占75.00%(45/60),真菌占5.00%(3/60)。革兰阳性菌主要为葡萄球菌,对替加环素、万古霉素和利奈唑胺的耐药率均为0.00%;对氨苄西林、苯唑西林和阿莫西林/克拉维酸耐药率超过75.00%;革兰阴性菌主要为大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌,其中大肠埃希菌、肺炎克雷伯菌对氨曲南耐药率最高,对亚胺培南和美罗培南最低,鲍曼不动杆菌对常用抗菌药物均表现出不同程度耐药性。结论该院ICU导管相关性血流感染病原菌以革兰阴性菌为主,存在真菌感染,抗菌药物耐药率较高,临床应加强导管监测,准确合理应用抗菌药物。
Objective To evaluate the distribution and drug resistance of pathogens in catheter-related bloodstream infections in intensive care unit (ICU) and provide basis for clinical diagnosis and treatment. Methods Bacterial culture, biochemical identification and drug sensitivity test were performed on 414 cases of suspected catheter-related bacteremia (CRBSI) catheter tip and peripheral venous blood samples in ICU. The results were confirmed 60 cases of CRBSI positive specimens, isolates of 60 pathogens, Gram-positive bacteria accounted for 20.00% (12/60), Gram-negative bacteria accounted for 75.00% (45/60), fungi accounted for 5.00% (3/60). Gram-positive bacteria were mainly staphylococci, and resistance rates to tigecycline, vancomycin and linezolid were both 0.00%. The rates of resistance to ampicillin, oxacillin and amoxicillin / clavulanate exceeded 75.00%; Gram-negative bacteria mainly Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii, of which Escherichia coli, Klebsiella pneumoniae aztreonam resistant rate was highest, imipenem South and Meropenem minimum, Acinetobacter baumannii commonly used antimicrobial drugs showed varying degrees of resistance. Conclusion The pathogen of duct-related bloodstream infection in ICU of the hospital is mainly Gram-negative bacteria, which has fungal infection and high antimicrobial resistance rate. It is necessary to strengthen catheterization monitoring in clinical practice, and use antibacterial drugs accurately and reasonably.