重症监护病房获得性感染病原菌耐药分析

Analysis of Pathogens of Nosocomial Infection in Intensive Care Units and Related Drug-resistance

目的调查重症监护病房(ICU)医院感染的病原菌的构成、感染部位的分布及细菌耐药性监测,指导临床合理使用抗生素。方法采用法国梅里埃的vitek-II全自动细菌鉴定仪及配套的鉴定卡和药敏卡,对重症监护病房送检的各种标本按细菌检验常规程序操作。结果分离到病原菌343株,其中革兰氏阴性菌224株(65.31%),革兰氏阳性菌71株(20.70%),真菌48株(13.99%)。前3位病原菌为铜绿假单胞菌(16.33%)、产超广谱内酰酶(ESBLs)的肺炎克雷伯菌菌株(14.29%)、白色念珠菌(12.54%)。铜绿假单胞菌对头孢他啶、哌拉西林/他唑巴坦外,其余均不敏感。病原菌检出率以下呼吸道感染最高,占69.39%,其次是泌尿道(16.62%)。结论重症监护病房医院获得性感染以铜绿假单胞菌为主,耐药菌株多,耐药问题严重,应加强药性监测,合理使用抗生素,进行目标性细菌学监测治疗。

Objective To investigate the constitutions of pathogens of nosocomial infection in intensive care units, the distribution of the sites where infections taken place and the drug - resistance of bacteria. Methods The drug - resistance of bacteria of nosocomial infection in intensive care units have been analyzed by applying automatic analyzer vitek -II ,with bacteria inspecting cards and drug - sensitivity cards, all from Bio - Merieux, France. Results Totally 343 strains of nosocomial pathogens have been isolated, which included gram negative bacteria, gram positive bacteria and fungi, with rates of 65.31% ,20. 70% , and 13.99%, respectively. Pscudomona aeruginosa, ESBLs - producing strains of klebsiella spp. and candida albicans ranked top three,with rates of 16. 33%, 14.29%, and 12.54%, respectively. About 69.39% of pathogens were found from the lower respiratory tract ,followed by urethra （16.62%）. Pseudomona aeruginosa showed sensitive to Ceftazidime and Piperacillin, However, presented its drug - resistance to the rest of regular antibiotics. Conclusion Pseudomona aeruginosa is a dominating pathogen to cause nosocomial infection in intensive care units, and most strains of pathogens has shown strong multi - drug - resistance. It comes to be crucial to inspect the character of the drugs, apply proper antibiotics and adopt the targeting therapy according to the bacteriological inspection in order to reduce appearance of bacteria with drug - resistance.