ICU院内感染流行菌株及耐药情况

Prevailing strains and drug-resistances of nosocomial infections in ICU

目的 了解ICU院内感染的流行菌株及菌株耐药 ,为临床防治提供依据。方法 对温州医学院附属第一医院ICU2 0 0 2年 7月～ 2 0 0 3年 6月所有分离的细菌菌株、真菌菌株及菌株耐药性进行回顾性调查。结果 共检出菌株 170例 ,其中G-菌 95例 (占 5 5 9% ) ,以铜绿假单胞菌、洋葱假单胞菌、鲍曼不动杆菌为主 ,主要见于呼吸道感染 ;G+ 菌 36例 (占 2 1 2 % ) ,以肠球菌和葡萄球菌为主 ,前者主要见于泌尿道和消化道感染 ,后者均见于呼吸道 ;真菌 38例 (占 2 2 4 % ) ,以白色念球菌为主 ,主要见于泌尿道感染。其细菌对常用抗菌药耐药严重 ,呈多重耐药 ,真菌耐药率尚低。结论 加强室内外环境和空气监控 ,防止交叉感染 ,侵入性操作要严格无菌操作 ,在积极治疗原发病的基础上加强支持疗法 ,增强机体免疫能力 ,严格掌握抗生素使用原则 ,根据药敏选用抗生素 ,避免长期大量联合用药 ,减少抗生素使用率 。

Objectives To investigate prevailing strains and drug-resistances of nosocomial infections in ICU,contributing to future clinical prevention and treatement.Method A retrospective investigation was made for all the isolated bacteria and fungi strains as well as their drug-resistances from July 2002 to June 2003 in ICU of our hospital.Results 170 strains were isolated,including 95 G - strains(55.9%),36 G + strains(21.2%)and 38 fungi(22.4%).G - strains were mainly isolated from respiratory infections,which included Pseudomonas aeruginosa,Pseudomonas cepaica and Acinetobacter bauamnnii,etc.G + strains mainly consisted of Enterococcus and Staphylococcus.Enterococcus was mainly isolated from urinary and alimentary canal infections,while Staphylococcus from respiratory.The major Fungi were Candida albicons isolated mainly from urinary canal infections.Bacteria were highly resistant to usual antimicrobial drugs and demonstrated multi-drug-resistance,while drug-resistant rate of Fungi was lower.Conclusion In order to decline nosocomial infections in ICU the following methods were recommended;enhancing environmental and aerial monitoring inside and outside ICU,awiding across infection,adapting aseptic courses in invasive procedures,intensifying supportive treatment on the basis of actively treating the primary affection,raising immune functions of patients,keeping good utilization principles for antimicrobial drugs,selecting antimicrobial drugs according to drug-sensitivity tests,forbidding long-term strategies of combined antimicrobial drug utilization,declining utilizatin rate of antimicrobial drugs.