重症监护病房医院感染临床分析

Clinical Analysis of Hospital Acquired Infection in Intensive Care Unit

目的:为防治ICU的医院感染提供临床依据。方法:对我院ICU收治的住院时间大于3d的796例患者的病历资料进行回顾性分析。结果:796例中,发生医院感染201例(25.3%)。其中APACHEⅡ>20分者341例,发生医院感染172例(50.4%);APACHEⅡ<20分者455例,发生医院感染29例(6.4%)。医院感染发生在患者不同性别间无差异(P>0.05),而在不同年龄、病情危重度间差异有显著性(P均<0.01),201例感染者中,99例为下呼吸道感染(占49.2%),其中呼吸机相关肺炎68例,占肺部感染中68.7%,54例为胃肠道感染(26.9%),泌尿道29例(14.4%),其他19例(9.5%);最常见的病原菌依次为肺炎克雷伯杆菌(28.5%)、鲍曼不动杆菌(26.4%)、铜绿假单胞菌(18.3%)、嗜麦芽窄食单胞菌(8.2%)、葡萄球菌(6.7%)、肠杆菌(6.1%)、其他(5.8%)。各病原菌对抗菌药物的耐药性均较严重,肺炎克雷伯菌对MERO、IMP和CFS敏感率分别为54.8%、59.9%、44.7%,其余耐药率均较高,而鲍曼不动杆菌对抗菌药物的敏感情况同肺炎克雷伯菌相似,铜绿假单胞菌对CAZ、IMP耐药率日渐增高。结论:ICU内医院感染发生率较高,与年龄、病情危重度相关;尽早控制病情、严格无菌操作、合理应用抗生素是防止耐药菌产生、控制和降低医院感染的关键。

Objective： To Provide the clinical evidence of hospital acquired infection in intensive care unit（ICU）. Methods：Clinical data of 796 patients hospitalized in ICU for over 3 days were reviewed retrospectively. Results：Among 796 cases, 201 cases developed hospital acquired infection, with an incidence of 25. 3% 341 cases with an APACHE Ⅱ score of over 20,172 developed hospital acquired infection, with an incidence of 50. 4%. 455 cases with an APACHE I1 score of less then 20,29 cases developed hospital acquired infection, with an incidence of 6. 4%. There was no significant difference between the incidence of hospital acquired infection and gender, but there was a significant difference between hospital acquired infection and the age and the severity of the patient＇s condition （P〈0. 01）. Among 201 cases of hospital acquired infection, 99 cases （49. 2%） presented lower respiratory tract infection, including 68 cases of ventilator-related pneumonia,with 68. 7% incidence of lung infection, 54 cases （26. 9%） presented gastroenterol infection, 29 cases （14. 4%） with urinary tract infection, 19 cases （9. 5%） with other infections. The major pathogens are k. penumoniae（28. 5%）, Acinetobacter baumannii（26. 4 %）, Pseudomonas aeruginosa （ 18. 3%）, Stenotrophornonas maltophilia （8.2 %）, Staphylococcus （ 6. 7 % ）, Enterobacteria （6. 1% ）, others （ 5.8 % ）. Each manifesting remarkable drug-resistance. Except for the sensitive rate of k. penumoniae to MERO, IMP and CFS were 54. 8%, 59. 9% ,44. 7%,others have a high rate of drug-resistance, but the sensitive rate of Acinetobacter baumannii to antibiotics is similar to k. penumoniae. Drug resistance rate of Pseudomonas aeruginosa to CAZ and IMP were increased gradually. Conclusions： Hospital acquired infection is rather common in ICU, in correlation with the age and the severity of the disease. To control the severity as soon as possible, steriled procedures and use antibiotics properly is the key point for preventing drug-resistance and controlling hospital acquired infection.