急诊科病房感染性疾病病原菌检出率及分布特点分析

Analysis on Pathogenic Bacteria of Infectious Disease in Emergency Department

【目的】了解急诊病房感染性疾病病原茵分布特点，为感染性疾病的防治提供参考依据。【方法】留取2009~2011年本院急诊病房疑似感染患者的痰液、血液、尿液、皮肤黏膜分泌物等标本2019份，应用法国生物梅里埃公司ATB微生物鉴定系统进行细菌鉴定，按CLSI判断结果。【结果】2019份标本病原菌检查阳性率32．39％，混合感染率25．73％。痰液和尿液标本阳性占比较高（分别为60．09％和19．88％）。654株分离菌株中，革兰阴性杆菌、阳性球菌和酵母样真菌分别占69．27％、19．11％和11．62％。前10位常见病原茵分别为大肠埃希茵、肺炎克雷伯菌、铜绿假单胞茵、金黄色葡萄球菌、鲍氏不动杆菌、白假丝酵母菌、奇异变形杆茵、阴沟肠杆茵、土生克雷伯茵和屎肠球菌。各类感染性疾病检出病原菌分布呈现不同的特点，呼吸道感染以肺炎克雷伯茵、铜绿假单胞茵、鲍氏不动杆菌和金黄色葡萄球菌为主（14％～18％），泌尿道感染以大肠埃希茵为主（34％～62％）。【结论】急诊科病员病情复杂且危重，感染性疾病的患病率较高，及时了解病原茵特点和感染类型，对感染性疾病的防治具有重要意义。

[Objective] To understand the distribution characteristics of pathogenic bacteria of infectious diseases in emergency department in order to provide the basis for the prevention and therapy of infectious dis- eases. [Methodsl The samples of sputum, blood, urine and secretions from skin and mucosa in suspected in- fectious patients in emergency department of our hospital were collected from 2009 to 2011. The ATB system was applied to identify different strains. Results were analyzed according to CLSI. [Results] The positive rate of pathogenic bacteria in 2019 samples was 32.39%. The mixed infectious rate was 25. 730%. The positive rate of the samples from respiratory tract and urinary tract were higher（60.09% and 19.88%, respectively）. The 654 isolated strains included 69.27 %of Gram-negative bacteria, 19.11 % of Gram-positive cocci and 11.62 % of fungi. The first 10 common isolates were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aerugino- sa, Staphylococcus aureus, Acinetobacter baumannii, Candida albicans, Proteus mirabilis, Enterbacter cloa- cae, Native Klebsiella and Enterococcus faecium. The distribution of the pathogens from different infectious diseases had a variety of characteristics. The main pathogens of respiratory tract infection were Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus （14%-18%）. The main pathogens of urinary tract infection were Escherichia coli（34.62 M）. [Conclusion] The patients ad- mitted to the emergency department are in severe and complicated conditions. The prevalence of infectious dis- eases is high. It is very important to understand timely the features and the infectious types of pathogens for prevention and treatment of infectious diseases.