NICU医院感染患者的病原菌谱及耐药性研究

Bacterial spectrum of NICU patients with nosocomial infections and analysis of drug resistance

目的分析神经内科重症监护病房(NICU)医院感染患者的临床和病原菌谱及耐药性,为医院感染的控制提供依据。方法选取2010年9月-2011年9月某医院NICU的住院患者为研究对象,对发生医院感染的患者按规范采集相应的血、尿、便、痰、分泌物等标本,进行病原学检查及药敏试验。结果 224例住院患者中有65例发生医院感染,感染率为29.02%,感染部位中下呼吸道占90.24%;检出病原菌中革兰阴性杆菌占75.46%,主要为铜绿假单胞菌和肺炎克雷伯菌,革兰阳性球菌占17.79%,主要为金黄色葡萄球菌,真菌占6.75%;铜绿假单胞菌虽然对多数抗菌药物具有很强的耐药性,但对左氧氟沙星敏感,而肺炎克雷伯菌对哌拉西林/他唑巴坦等多种抗菌药物具有较高的敏感性。结论加强NICU患者的呼吸道和病房工作人员手卫生管理及避免抗菌药物滥用,是预防NICU患者发生医院感染的重要措施。

OBJECTIVE To analyze the clinical characteristics, bacterial spectrum and drug resistance of the pathogens causing nosocomial infections in the neurological intensive care unit （NICU） and to provide the basis for the control of nosocomial infections. METHODS The patients in NICU of a hospital in Tangshan from Sep 2010 to Oct 2011 were selected as subjects of this study. The blood, urine, stool, sputum, secretions and other specimens of the patients with nosocomial infections were obtained and the pathologic examination and drug susceptibility tests were conducted. RESULTS There were 65 cases of nosocomial infections in 224 patients. The infection rate was 29.02%. Lower respiratory tract was the main site of infections and the constituent ratio was 90.24%. The gram-negative bacilli were the main pathogens and the constituent ratio was 75.46 % . They were mainly Pseudo- monas aeruginosa and Klebsiella pneumoniae. The gram-positive cocci accounted for 75.46 % ,and mainly Staphy- lococcus aureus. Fungi accounted for 6.75%. P. aeruginosa has a strong resistance to most antimicrobial drugs, and was susceptible to levofloxacin. K. pneumoniae was susleptihle to most antimicrobial drugs such as piperacillin/tazobactam. CONCLUSION To strengthen the management of the respiratory tract of the NICU patients and the hand hygiene of the ward staff and avoid the abuse of antibiotics is an important way to prevent nosocomial infections in NICU.