脑胸外科ICU内获得性感染的致病菌菌种及其药敏

The Acquired Infection of Patients in An Encephalo-thoracic Surgical ICU in Hospital

目的研究脑胸外科ICU内患者的获得性感染的发生率、致病菌、药敏与耐药情况。方法分析2000年1月～2003年12月脑、胸外科ICU住院中的56例院内获得性感染患者的呼吸道分泌物、尿、血的细菌培养、药敏资料。结果56例中呼吸道感染50例,58次痰培养阳性37例,阳性率63.7%。其中细菌32株,占86.4%,共14个菌种;真菌5株,占13.5%。送痰检厌氧菌6例,阳性2例,细菌与真菌混合感染5例,二重感染率15.6%。尿路感染5例,中段尿培养6次,阳性2例,阳性率33.3%,细菌2株,2个菌种。败血症1例血培养阳性,细菌1株。革兰氏阳性菌(G+)主要是金黄色葡萄球菌(17%),缓症链球菌(8.5%)。革兰氏阴性菌(G-)主要是铜绿假单孢菌(22.9%),肺炎克雷伯氏菌(20%),嗜麦芽窄食单孢菌(5.7%)。药敏试验结果为铜绿假单孢菌、恶臭假单孢菌、嗜麦芽窄食单孢菌对多粘菌素E100%敏感;铜绿假单孢菌、恶臭假单孢菌、肺炎克雷伯菌、肠杆菌科细菌、不动杆菌属对亚胺培南敏感率为87.5%～100%;但嗜麦芽窄食单孢菌对亚胺培南100%耐药;大肠埃希菌等对亚胺培南、三代头孢、阿米卡星仍较敏感;金黄色葡萄球菌对万古霉素最敏感,对利福平、呋喃妥因有83.3%敏感率;各类细菌对三代头孢和喹诺酮类均有较高的耐药率,但呱啦西林+他唑巴坦、阿米卡星的敏感率仍较高。结论ICU内获得?

Objective To study the acquired infection rate, pathogens, drug sensitivity and drug resistance of patients in an encephalo thoracic surgical ICU in hospital.Method Samples obtained from 56 patients in the encephalo thoracic surgical ICU were subjected to bacterial cure and drug sensitivity analysis.Results Of the 56 subjects, 50 had respiratory tract infection. 37 cases(63 7%) showed positive in 58 times sputum cultures. In which 32 cases(86.4%) cases had bacterial infection, and 14 bacterial strains were identified. 5 cases(13 5%) had fungal infection. 6 cases were analyzed for anaerobes in sputum, and 2 showed positive. 5 patients showed combined infection of bacteria and fungi, with a rate of 15 6%.Of the 56 subjects, 5 had the urinary tract infection. 2(33.3%) out of 6 showed positive in midstream urine culture test and 2 bacterial strains were identified. Of the 56 subjects, one had septicemia and showed positive in blood culture test. One case was infected with Gram positive and Gram negative bacteria. Gram positive bacteria(G+) mainly included Staphylococcus aureus (17%), and Streptococcus milis(8 5%), while Gram negative bacteria (G-) mainly included P.aeruginosa(22 8%), K.pneumoniae(20%),and X.maltophilia(5 7%). The result of drug sensitivity test showed that P. aeruginosa, P. putida, and X.maltophilia were sensitive to polymyxin E (100%); P. aeruginosa, P. putida,K.pneumoniae, Enterobacteriaceae, and Acinebacter were sensitive to imipenem (87 5%～100%); X. maltophilia was resistant to imipenem (100%).E.coli was still more sensitive to imipenem, 3rd generation cephalosporins, and amikacin. Staphylococcus aureus, most sensitive to vancomycine, was sensitive to rifampicin and nitrofurantoin (83 3%). The all bacteria showed a high resistance to 3rd generation cephalosporin and 3rd generation quinolones, but high sensitivity to piperacillin with tazobactam and amikacin.Conclusions Acquired infection of patients in encephalo thoracic surgical ICU is a severe problem encountered in treatment. Bacteria strains show resistance or cross resistance to antibiotics become more popular in ICU, which causes the difficulty of modern anti infective treatment. Abuse of antibiotic is one of the important reasons leading to resistance or cross resistance to antibiotics.