外科重症监护病房医院感染病原菌类型临床分析

Clinical Analysis of Pathogenic Bacteria Types of Hospital Infection in Surgery Intensive Care Unit.

目的：对外科重症监护病房（SICU）住院患者医院感染病原菌类型进行目标监测，指导临床合理使用抗菌药物。方法：2007年1～6月，对SICU发生的67例医院感染患者的痰液、血液、尿液、脓液、穿刺液标本共175份进行统计分析。结果：共检测出病原菌124株（70．85％），细菌112株（90．32％）、真菌12株（9．68％），细菌中革兰阴性杆菌83株（66．94％），革兰阳性球菌29株（23、39％）。革兰阴性杆菌主要为肺炎克雷伯菌、大肠埃希菌、阴沟杆菌、鲍曼不动杆菌、铜绿假单胞菌；对三代、四代头孢菌素、氨基糖苷类、磺胺类耐药，对亚胺培南、左氧氟沙星、哌拉西林／他唑巴坦、头孢哌酮／舒巴坦较敏感；革兰阳性球菌为凝固酶阴性葡萄球菌、金黄色葡萄球菌、溶血葡萄球菌，葡萄球菌大多数为耐甲氧西林葡萄球菌，多数对青霉素类、头孢类、氨基糖苷类、大环类、氟喹诺酮类耐药，对万古霉素、链阳霉素、呋喃妥因、利奈唑烷敏感；真菌以丝状霉菌为主，对氟康唑、依曲康唑、两性霉素B、5氟胞嘧啶敏感。结论：重视SICU患者标本的细菌学监测，加强抗菌药物使用的宏观控制，强化医务人员以细菌培养及药敏试验结果合理使用抗菌药物，有效预防SICU医院感染的发生。

Objective： Target monitoring on pathogenic bacteria types of in-patients＇hospital infection in surgery intensive care unit （ SICU ） can guide rational use of antibiotic in clinic. Methods： 175 specimens including sputum, blood, urine, pus and paracentesis fluid of 67 hospital infection patients in SICU have been statistical analyzed from Jan. to Jun in 2007. Results： 124 （70.85% ） strains of pathogenic bacteria , 112 （90.32% ） strains of bacteria and 12 （9.68% ） strains of fungus are checked out comparatively. 112 strains of bacteria consist of 83 （66.94% ） strains of gram-negative bacilli which include klebsiella pneumonia, escherichia coli, enterobacter cloacae, acinetobacter Baumannii and pseudomonas aeruginosa which are drug-resistant to the third and the fourth generation cephalosporin, aminoglycoside and sulfonamides, but sensitive to imipenem, levofloxacin, piperacillin and cefoperazone, and 29 （23.39% ） strains of gram-positive cocci, which include coagulase negative staphylococci, staphylococcus aureus, staphylococcus haemolyticus and enterococcus faecalis, which are drug-resistant to penicillins, cephalosporin, aminoglycoside and macrolides, but sensi- tive to vancomycin, streptogramin, nitrofurantoin and linezolid. The main strains of fungus is filamentous fungus which is sensitive to flu- conazole, itraconazole, amphotericin b and 5 flucytosine. Conclusion： By valuing bacteria monitoring of SICU patients＇ samples, strengthening anti-bacteria medicine control and reasonably using anti-bacteria medicine, we can reduce the SICU hospital infection.