重症监护病房连续3年血流感染的病原分析

Incidence and pathogens of bloodstream infections in ICU

目的:了解重症监护病房(ICU)血流感染的发病率和病原体特点及其耐药情况。方法:收集中日友好医院ICU2006年1月～2008年12月血流感染的资料进行回顾性分析。结果:3年间ICU共有住院患者1526例,其中血流感染64例(95次),总发病率为4.2%,2006年、2007年、2008年的发病率分别为5.4%(28/520)、4.4%(22/499)和2.8%(14/507)。分离病原体103株,G+菌66株(64.1%),G-菌26株(25.2%),真菌11株(10.7%)。常见病原菌为凝固酶阴性葡萄球菌(CNS,42.7%)、真菌(10.4%)、铜绿假单胞菌(9.7%)、金黄色葡萄球菌(6.8%)、鲍曼不动杆菌(4.9%)、屎肠球菌(5.8%)、粪肠球菌(3.9%)、大肠埃希菌(3.9%)。药敏结果显示,7株金葡菌中甲氧西林耐药金葡菌占86%,44株CNS中甲氧西林耐药CNS占95%。G-菌多重耐药的情况较常见。结论:ICU血流感染发病率3年来有所下降。病原体以G+菌为主,常见致病菌有CNS、真菌、铜绿假单胞菌、金黄色葡萄球菌、鲍曼不动杆菌、屎肠球菌、粪肠球菌、大肠埃希菌。引起血流感染病原体的耐药性较高。

Objective：To investigate the incidence,pathogens and antibiotic resistance of the pathogens of bloodstream infections in ICU of China-Japan Friendship Hospital.Methods：The data of incidence and pathogens of bloodstream infection（BSI）reported from Jan 2006 to Dec 2008 in ICU of the hospital were collected and analyzed.Results： 1526 patients were surveyed and 64 cases of bloodstream infection were reported. The incidence rate of bloodstream infection was 4.2%,the incidence rate of year 2006,2007 and 2008 were 5.4%,4.4% and 2.8%. 105 strains of pathogens had been isolated, among which 66 （64.1%） were gram-positive bacteria,26（25.2%） were gram-negative bacteria, 11 （10.4%）were fungi.The main causative organisms were coagulase negative staphylococcus （CNS, 42.7% ）, fungi （10.4%）, P.aeruginosa （9.7%）, S.aureus （6.8%）, acineto-bacter baumannii （4.9%）, enterococcus faecium （5.8 %）, enterococcus faecalis （3.9%）, escherichia coli （3.9%）.Susceptibility tests in vitro showed that methicillin resistant staphylococcus aureus was 86%,while in methicillin resistant coagulase negative staphylococcus was 95%.Among the prevalent Gram-negative BSI isolates,resistance rates for most of the antimicrobial agents were high.Conclusion：The tendency of incidence of bloodstream infection in the recent three years were decreasing.Gram-positive bacteria were the prominent pathogens.The most common pathogens were CNS,fungi,P.aeruginosa,S.aureus and enterococcus.The resistance of the pathogens were high.