新建ICU病原菌分布及耐药性调查分析

Analysis of distribution and drug-resistance of pathogens in a new intensive care unit

目的了解新建ICU启用后患者医院感染状况,探讨其流行菌株及细菌耐药性,为ICU经验性抗感染治疗提供科学依据。方法对2009年8月23日-2010年8月22日入住新建ICU时间>48h患者的各种体液标本进行培养,分离病原菌,进行耐药性分析。结果新建ICU患者医院感染率为72.6%;所有病原菌中,革兰阴性菌占78.5%,其中鲍氏不动杆菌占23.6%,铜绿假单胞菌占20.8%,洋葱伯克霍尔德菌占18.7%,革兰阳性菌占5.5%,真菌占16.0%,真菌以白色假丝酵母菌为主;鲍氏不动杆菌除对头孢哌酮/舒巴坦耐药率为38.2%外,对其他抗菌药物耐药率均>79.0%;金黄色葡萄球菌和表皮葡萄球菌均对青霉素类耐药,对万古霉素、替考拉宁及利奈唑胺敏感,敏感率>90.0%。结论革兰阴性菌是新建ICU患者医院感染的主要致病菌,ICU医院感染的治疗首先需覆盖革兰阴性菌,根据药敏分析,头孢哌酮/舒巴坦可作为经验性治疗的首选;若考虑存在假丝酵母菌属感染,氟康唑可作为首选。

OBJECTIVE To investigate the epidemiology of hospital infection,distribution and drug resistance of pathogens in the new intensive care unit（ICU）.METHODS Different fluid samples were collected from critically ill patients who stayed in the new ICU for more than 48 hours from August 2009 to August 2010.The distribution and drug-resistance of pathogens were analyzed.RESULTS The incidence of nosocomial infection is 64.5% in the new ICU.The main pathogens consisted of gram-negative bacteria（78.5%）,gram-positive bacteria（5.5%）,fungi（16.0%）.The top 3 gram-negative pathogens were Acinetobacter baumannii（23.61%）,Pseudomonas aeruginosa（20.83%） and Burkholderia cepacia（18.75%）.Camdida albican is the main Fungi,which is susceptibility to fluconazol.CONCLUSION Gram-negative bacteria are the main pathogens in new ICU,empiric antibiotic therapy should focus on them.Sulperazon could be the first choice according to drug susceptibility,and fluconazol could be chose empirically once invasive fungal infection is suspected.