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目的探讨重症监护病房(ICU)及非ICU患者导管相关性血流感染(CRBSI)的发生、病原菌分布及其耐药性,为其预防控制、合理使用抗菌药物提供科学依据。方法对2013年1月-2014年12月医院ICU及非ICU留置中央静脉导管(CVC)的患者进行前瞻性监测,统一CRBSI诊断标准分析其临床特点、病原菌构成和药物敏感试验结果。结果 2013年1月-2014年12月共监测患者4 175例,累计中央静脉置管日共38 984d,发生CRBSI 125例次,CRBSI感染率为3.21‰;共分离出病原菌131株,其中革兰阴性菌74株占56.49%,革兰阳性菌37株占28.24%,真菌20株占15.27%;主要的病原菌中耐甲氧西林凝固酶阴性葡萄球菌、耐碳青霉烯类肺炎克雷伯菌、产ESBLs大肠埃希菌、耐美罗培南铜绿假单胞菌检出率分别为75.0%、23.5%、30.8%、33.3%;凝固酶阴性葡萄球菌对万古霉素、利奈唑胺、替加环素、呋喃妥因的敏感率均为100.0%,铜绿假单胞菌对氨基糖苷类、喹诺酮类耐药率低,均<10.0%,热带念珠菌对伊曲康唑和氟康唑耐药率为50.0%和25.0%。结论监测ICU以及非ICU的CRBSI发生以及病原学变化,有助于进一步加强有效的预防控制措施和提供早期的经验性抗菌药物治疗方案。
Objective To investigate the incidence of catheter-associated bloodstream infection (CRBSI), pathogen distribution and drug resistance in intensive care unit (ICU) and non-ICU patients and provide a scientific basis for its prevention and control and rational use of antimicrobial agents. Methods Patients in ICU and non-ICU patients with central venous catheter (CVC) from January 2013 to December 2014 were prospectively monitored. CRBSI diagnostic criteria were used to analyze the clinical features, pathogenic bacteria composition and drug susceptibility test results. Results A total of 4 175 patients were monitored from January 2013 to December 2014. The cumulative total number of central venous catheters was 38 984 days, 125 cases of CRBSI occurred, and the infection rate of CRBSI was 3.21 ‰. A total of 131 pathogens were isolated, of which Gram 74 strains of negative bacteria accounted for 56.49%, 37 strains of gram-positive bacteria accounted for 28.24%, fungi 20 strains accounted for 15.27%; the main pathogens methicillin-resistant coagulase-negative Staphylococcus aureus, carbapenem-resistant Klebsiella pneumoniae , ESBLs-producing Escherichia coli, meropenem-resistant Pseudomonas aeruginosa were 75.0%, 23.5%, 30.8%, 33.3%; coagulase-negative Staphylococcus aureus vancomycin, linezolid, The susceptibility rate of all isolates to nitrofurantoin and nitrofurantoin were all 100.0%. The resistance rate of Pseudomonas aeruginosa to aminoglycosides and quinolones was low, both <10.0%. The resistance rates of Candida tropicalis to itraconazole and fluconazole were 50.0 % And 25.0%. Conclusion Monitoring ICU and non-ICU CRBSI occurrence and etiological changes may help to further strengthen effective prevention and control measures and provide early empirical antimicrobial therapy regimens.