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目的了解临床重症监护病房泛耐药细菌的分布,其产生的特定环境及高危因素,探讨预防及治疗策略。方法回顾性分析2008年4月~2009年4月两家医院重症监护病房(ICU)临床泛耐药细菌的菌种分布及高危因素。结果2008年4月~2009年4月,临床重症监护病房共有26例患者感染泛耐药细菌,菌株包括鲍曼不动杆菌10株、铜绿假单胞菌5株、洋葱伯克霍尔德菌4例、阴沟肠杆菌3株、嗜麦芽假单胞菌3株、肺炎克雷伯菌1株。广谱抗生素使用、老年患者、免疫功能低下、气管导管与呼吸机的使用是泛耐药细菌感染的高危因素。结论建立耐药监控体系,采用综合的抗菌药物治疗控制病原菌耐药;对于高危患者及早隔离,并限制碳青霉烯类抗菌药物的使用,以降低泛耐药病原菌的产生及发展。
Objective To understand the distribution of pan-resistant bacteria in the clinical intensive care unit, its specific environment and risk factors, and to explore the strategy of prevention and treatment. Methods The clinical distribution and high risk factors of clinical pan-resistant bacteria in intensive care unit (ICU) from April 2008 to April 2009 were retrospectively analyzed. Results From April 2008 to April 2009, 26 patients in the ICU were infected with pan-resistant bacteria. The strains included 10 Acinetobacter baumannii, 5 Pseudomonas aeruginosa and 2 Burkholderia cepacia 4 cases, 3 strains of Enterobacter cloacae, 3 strains of Pseudomonas maltophilia and 1 strain of Klebsiella pneumoniae. The use of broad-spectrum antibiotics, elderly patients, immunocompromised patients, and endotracheal tubes and ventilators is a risk factor for pan-resistant bacterial infections. Conclusion The establishment of drug resistance monitoring system, the use of integrated antimicrobial drug therapy to control pathogenic bacteria resistance; early isolation for high-risk patients and limit the use of carbapenem antibacterial drugs to reduce the generation and development of pan-resistant pathogenic bacteria.