重症监护患者感染病原菌的分布特征及预防策略

DISTRIBUTION AND PREVENTIVE STRATEGY OF PATHOGENS IN THE INTENSIVE CARE UNIT

目的回顾性分析ICU患者医院内感染病原菌的构成及耐药性,并针对感染特点提出预防策略,以期为ICU内医院感染的控制和预防提供依据。方法收集2006年7月-2008年7月呼吸科、急诊科和神经外科ICU患者的各种标本分离的病原菌,对其分布、耐甲氧西林金黄色葡萄球菌(methicillin-resistance staphylococcusaureus,MRSA)的检出以及耐药性进行分析。结果共分离病原菌1 496株,其中大肠埃希菌最为常见(244株),占16.31%;其次是铜绿假单胞菌(206株)和鲍曼不动杆菌(187株),分别占所有菌株的13.77%和12.50%。金黄色葡萄球菌96株,其中MRSA 59株,占金黄色葡萄球菌的61.46%,MRSA的耐药性较高,对氯霉素和阿米卡星较敏感,耐药率分别为20.34%和55.93%,未发现对万古霉素耐药的葡萄球菌。大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌对亚胺培南和美罗培南较敏感,耐药率分别为0和2.87%、1.23%和2.47%、21.93%和22.99%。大肠埃希菌和肺炎克雷伯菌的ESBLs检出率分别为53.69%和61.73%。结论 ICU患者感染的病原菌对临床常用抗生素耐药性较高,往往对几类抗生素同时耐药。一旦发现可疑病例即实施隔离,同时进行病原学的检查,强化手卫生是预防和控制ICU内医院感染的重要措施。

Objective To investigate the bacterial distribution and the extent of drug resistance in intensive care unit(ICU)patients,and to provide basis for clinical therapy. Methods Collected a variety of pathogens from patients of ICU,respiratory,neurosurgical and emergency department from July 2006 to July 2008,the distribution,methicillin-resistance staphylococcus aureus(MRSA)detection and drug resistance were analysed.Results Totally 1496 pathogens were isolated,of which the most common was Escherichia coli(244),accounting for 16.31%,followed by Pseudomonas aeruginosa(13.77%)and Acinetobacter baumannii (12.50%),respectively.Among 96 strains Staphylococcus aureus,59 strains were MRSA, accounted for 61.46%.MRSA resistance was higher,the resistant rates for chloramphenicol and amikacin were 20.34% and 55.93%,no resistance against vancomycin were observed. Escherichia coli,Klebsiella pneumoniae and Acinetobacter baumannii were sensitive to imipenem and meropenem,the resistance rates were 0 and 2.87%,1.23% and 2.47%,21.93% and 22.99%,respectively.ESBLs detection rates of Escherichia coli and Klebsiella pneumoniae were 53.69% and 61.73%,respectively.Conclusion The pathogens from ICU shows the multidrug resistance.Pathogenic monitoring,keeping the patients apart,rational utilization of antibiotics, medical facility sterilization strictly and intensive hand hygiene are very important preventive measures for infections.