ICU 66例血流感染患者危险因素分析

Risk factors for bloodstream infections in 66 patients in ICU

目的了解重症监护病房(ICU)血流感染的危险因素、病原菌分布特点及其耐药性,为更好地预防和治疗血流感染提供帮助,从而降低血流感染的发病率和死亡率。方法对北京市海淀医院2009-2011年ICU 66例血流感染患者进行回顾性调查,对其危险因素、病原菌分布及耐药特点进行分析,并提出治疗与预防措施。结果 66例血流感染患者共检出病原菌70株,其中革兰阴性菌32株占45.7%,革兰阳性菌28株占40.0%,真菌10株占14.3%;其中较常见的病原菌为凝固酶阴性葡萄球菌、鲍氏不动杆菌、酵母菌属、洋葱伯克霍尔德菌、屎肠球菌、大肠埃希菌,分别占25.7%、12.9%、12.9%、10.0%、8.6%、8.6%;血流感染多预后不良,且死亡率高,达60.6%;慢性基础疾病、免疫力低下、侵入性操作及抗菌药物的滥用等是血流感染发生的危险因素。结论 3年ICU血流感染患者病原菌分布革兰阴性菌和革兰阳性菌基本持平,在革兰阴性菌中以鲍氏不动杆菌为主,而革兰阳性菌以凝固酶阴性葡萄球菌为主;严格无菌操作、细致的导管护理、加强血培养监测及合理使用抗菌药物是预防和治疗血流感染的有效措施。

OBJECTIVE To investigate the risk factors for bloodstream infections in the intensive care unit（ICU）,to analyze the distribution of pathogens and their drug resistance so as to provide basis for the prevention and treatment of bloodstream infections and reduce the incidence of bloodstream infections and the mortality.METHODS Totally 66 patients with bloodstream infections were investigated retrospectively in the ICU of Beijing Haidian Hospital between 2009 and 2011,the risk factors for bloodstream infections,the distribution of pathogens,and the drug resistance characteristics were analyzed.RESULTS A total of 70 strains of pathogens were isolated from 66 patients with bloodstream infections,including 32（45.7%） strains of gram-negative bacteria,28（40.0%） strains of gram-positive bacteria,and 10（14.3%） strains of fungi;the main pathogens causing bloodstream infections were coagulase-negative Staphylococci（25.7%）,Acinetobacter baumannii（12.9%）,Yeast（12.9%）,Burkholderia cepacia（10.0%）,Enterococcus feces（8.6%）,and Escherichia coli（8.6%）.Those patients with the bloodstream infections had poor prognosis and the mortality rate was high,up to 69.23%.The chronic underlying disease,low immunity,invasive operation,and the abuse of antibiotics were risk factors of bloodstream infections.CONCLUSION The distribution of the gram-negative bacteria is as basically same as the gram-positive bacteria in the pathogens causing blood stream infections in the ICU during the three years.A.baumannii is the main species of gram-negative bacteria,and coagulase-negative Staphylococci was the predominant species of gram-positive bacteria.The strict aseptic operation,careful nursing of catheter,intensifying the blood culture,and reasonable use of antibiotics are the effective measures to prevent and treat the bloodstream infections.