ICU细菌感染的分布特点监测与分析

Monitoring and analysis of distribution characteristics of bacterial infection in ICU

目的分析重症医学中心5年细菌感染的分布特点及耐药情况,为合理应用抗菌药物提供依据。方法选取2016年1月-2020年12月新疆医科大学第一附属医院重症医学中心住院患者,收集患者痰液、血液、尿液等送检标本中分离出多重耐药菌的相关的临床资料,通过回顾性分析,探究ICU耐药菌感染的分布特点。结果总共6417例细菌感染。ICU住院患者的标本中痰液等呼吸道分泌物占35.7%、尿液21%、血液13.6%、伤口脓液10.2%、胸腔积液4%、脑脊液0.8%、阴道分泌物1.1%、粪便1.9%和其他标本11.7%。革兰阴性杆菌是重症医学科的主要致病菌,其中肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌三者可占我科病原菌的45%以上。革兰氏阳性致病菌,以金黄色葡萄球菌最为常见,约5-7%,对万古霉素和利奈唑胺高度敏感,未检出耐药株,对青霉素的临床耐药率最高,最高可达98.7%。结论多重耐药细菌感染及耐药问题在ICU内仍旧严重,主动早期筛查并获得相关细菌的流行病学,有助于指导用药,降低ICU细菌耐药的发生。

Objective To analyze the distribution characteristics and drug resistance of bacterial infections in critical medical centers for five years,so as to provide the basis for guiding the rational use of antimicrobial drugs.Methods Hospitalized patients in the Critical Care Center of the First Affiliated Hospital of Xinjiang Medical University from January 2016 to December 2020 were selected,and the relevant clinical data of multi-resistant bacteria isolated from sputum,blood,urine,secretions and other submitted specimens were collected.Through retrospective analysis,the distribution characteristics of multi-resistant bacteria infection were explored.Results There were 6,417 cases of bacterial infection in total.Sputum and other respiratory secretions accounted for 35.7%,urine 21%,blood 13.6%,wound pus 10.2%,pleural effusion 4%,cerebrospinal fluid 0.8%,vaginal secretions 1.1%,feces 1.9%,and other specimens 11.7%of the specimens of hospitalized patients in the ICU.Gram-negative bacilli were the main pathogenic bacteria in the ward of Intensive Medical Center in our hospital,and Klebsiellapneumoniae,Acinetobacterbaumannii and Pseudomonas aeruginosa accounted for more than 45%of the pathogenic bacteria in our department.Gram-positive pathogenic bacteria,most commonly Staphylococcus aureus,accounted for about 5%-7%,were highly sensitive to vancomycin and linezolid,with no drug-resistant strains detected,and the clinical resistance rate to penicillin was the highest,up to 98.7%.Conclusion Multi-drug resistant bacterial infection and drug resistance are still serious in ICU.Active early screening and obtaining the epidemiology of related bacteria can help to guide drug use and reduce the occurrence of bacterial drug resistance in ICU.