重症监护病房患者泛耐药菌株的分布及相关因素分析

Study on pan-drug-resistant strains in intensive care units

目的了解临床重症监护病房泛耐药细菌的分布,其产生的特定环境及高危因素,探讨预防及治疗策略。方法回顾性分析2008年4月-2009年4月两家医院重症监护病房（ICU）临床泛耐药细菌的菌种分布及高危因素。结果2008年4月-2009年4月,临床重症监护病房共有26例患者感染泛耐药细菌,菌株包括鲍曼不动杆菌10株、铜绿假单胞菌5株、洋葱伯克霍尔德菌4例、阴沟肠杆菌3株、嗜麦芽假单胞菌3株、肺炎克雷伯菌1株。广谱抗生素使用、老年患者、免疫功能低下、气管导管与呼吸机的使用是泛耐药细菌感染的高危因素。结论建立耐药监控体系,采用综合的抗菌药物治疗控制病原菌耐药;对于高危患者及早隔离,并限制碳青霉烯类抗菌药物的使用,以降低泛耐药病原菌的产生及发展。

Objective To study the distribution of pan-drug-resistant oacter,d factors and specific conditions for their development and to investigate prevention and treatment strategies. Methods The distribution of pan-drug-resistant bacteria in ICUs in two hospitals from April 2008 to 2009 and risk factors and specific conditions for their development were analyzed retrospectively. Results The ICUs had 26 patients infected with pan-drug-resistant bacteria that broke down into 10 strains of A. baumannii, 5 strains of 19. aeruginosa, 4 strains of B. cepacia, 3 strains of E. cloacae, 3 strains of P. rnaltophilia, and 1 strain of K. pneumoniae. Receiving broad spectrum antibiotics, being elderly, having compromised immunity, and use of an endotracheal tube or respirator were risk vactors for infection with pan-drug-resistant bacteria. Conclusion Establishment of a drug resistance monitoring system, use of comprehensive antibacterial therapies to control pathogenic drug resistance, effective early isolation of high-risk patients, and limited use of carbapenem should decrease the growth and development of pan-drug-resistant bacteria.