新建综合性监护病房医院感染特点及病原菌耐药分析

Characteristics of hospital infection and pathogen drug-resistance in new intensive care unit

目的 了解新建综合监护病房（ICU）医院感染特点及病原学耐药情况,为临床合理用药提供依据.方法 采用回顾性调查方法,分析我院综合ICU成立1年来收治且纳入研究的142例患者的医院感染情况并与同期我院收治的其他住院患者相比较.结果 142例中共22例31例次发生医院感染,ICU医院感染率为15.49%,例次感染率21.83%;同期我院共收治住院患者15 978例,其中324例413例次发生医院感染,医院感染率为2.03%,按例次计为2.58%.ICU与全院医院感染率相比,差异有统计学意义（P均＜0.01）.ICU感染好发部位主要为下呼吸道感染,占70.96%;病原菌以革兰阴性杆菌为主（65.12%）,其次为革兰阳性球菌（23.26%）及真菌（11.63%）;最常见病原菌为大肠埃希菌（32.56%）及金黄色葡萄球菌（11.63%）;革兰阴性菌对头孢哌酮/舒巴坦、亚胺培南、美洛培南、哌拉西林/他唑巴坦均高度敏感;革兰阳性菌对万古霉素、利奈唑胺、替考拉宁100%敏感.结论 新建ICU医院感染病原菌在构成、分布及耐药性等方面与国内研究结果基本一致;革兰阴性菌为其主要病原菌,大肠埃希菌占医院感染的第一位.

Objective To study characteristics of hospital infection and bacterial drug-resistance in our new Intensive Care Unit （ICU） to provide evidence to clinical rational use of drugs. Methods The data of 142 patients in our ICU last year were analyzed retrospectively, and compared to other inpatients treated in general ward during the same time period. Results Among the 142 ICU inpatients,31 times of hospital infection occurred in 22 patients,gave rise to a infection rate of 15.49% and case time infection rate of 21.83% in ICU; but among the 15 978patients treated simultaneously in general ward,413 times of hospital infection occurred in 324 inpatients, gave rise to a infection rate of 2. 03% and case time infection rate of 2. 58% outside of ICU. The hospital infection rate and case time infection rate were significantly different between the ICU and general ward （P 〈 0. 01 ）. Among the ICU infections, the lower respiratory tract infection accounted for 70. 96% ;the main pathogens were Gram-negative bacilli （65. 12%） and Gram-positive bacilli （23.26%）, follwed by fungus （ 11.63% ）. The most common bacteria were Escherichia （32. 65% ） and Staphylococcus （11.63%）. Gram-negative microorganisms were highly sensitive to cefoperazone/sulbactam,imipenem,meropenem and piperacillin/tazobactam;all Gram-positive microorganisms were sensitive to vancomycin, linezolid and teicoplanin. Conclusions The constitution,distribution and drug-resistance of pathogens in new ICU are similar to previous domestic reports. Gram-negative organisms are the main photogenic bacteria of hospital infection in ICU,and Escherichia is the most popular type in nosocomial infection.