神经外科重症监护病房的细菌耐药性监测

Epidemiology and Antibiotic-resistance of Nosocomial Infection Strains in NSICU Survey

目的观察天坛医院神经外科重症监护病房(NSICU)医院获得性细菌感染的病原菌及耐药情况。方法分阶段监测和总结北京天坛医院NSICU 1995-2009年3月所有细菌分离株及耐药性。结果细菌共计1314株,革兰阴性菌830株(63.2%),革兰阳性菌484株(36.8%);排前6位菌株依次是金黄色葡萄球菌、不动杆菌属、铜绿假单胞菌、肺炎克雷伯菌、嗜麦芽寡养单胞菌、大肠埃希菌;感染部位为肺部感染91.2%、脑脊液感染3.8%、其他感染4.9%。结论NSICU中以肺部感染为主,革兰阴性菌多见;系统监测NSICU感染的特点及其细菌耐药动态,是临床合理使用抗菌药物的重要前提;降低NSICU感染率的重点是控制肺部感染,其他综合性治疗措施也应予以重视。

OBJECTIVE To observe the type of nosocomial infections in our neurosurgical ICU （NSICU）, the prevalence and the characteristic of infection strains, and the change in antibiotic-resistance. METHODS The species and resistance pattern all the bacterial isolates in NSICU of Tiantan Hospital from Jun 1995 to Mar 2009 were retrospectively analyzed. RESULTS Among all 1314 bacterial isolates, Gram-negative bacilli were 830 （63.2 %） strains and Gram-positive cocci were 484 （36.8 %）. The top six strains were in turn.. Staphylococcus aureu , Acinetobacter baumannii , Pseudomonas aeruginosa , Klebsiella pneumonia, Stenotrophomonas maltophiliae and Escherichia coll. Distribution of infection sites： 91. 2% infection was in lungs, 3. 8%in CSF and 4. 9% in other sites. CONCLUSIONS The main nosocomial bacterial infection in NSICU is lung infection. The prevailing nosocomial infective pathogens in NSICU are Gram-negative bacilli. A systematic monitoring of the characteristics of etiology and pathogenic bacteria resistance to drugs in the patients with nosocomial infection in our NSICU is prerequisite to rational use of antibiotics. The control of lung infection and application of comprehensive preventive therapeutic measures are the key to reduce nosocomial infection in NSICU patients.