MICU患者留置导管培养结果分析

Culture for indwelling catheters of patients in medical intensive care unit

目的分析内科重症监护病房(MICU)患者各种留置导管(包括气管插管、深静脉导管、留置导尿管和留置胃管)的微生物定植以及相关感染等,为临床预防医院感染提供依据。方法对2009年9月-2010年5月MICU患者各种留置导管及送检临床标本进行培养,结合患者的临床资料进行判断。结果共培养标本224份,其中气管插管标本58份,培养阳性55份,阳性率94.8%,发生VAP17例,发生率为29.3%,检出病原菌以鲍氏不动杆菌及铜绿假单胞菌为主;深静脉留置针标本33份,培养阳性5份,阳性率为15.2%,发生导管相关性血流感染1例,发生率为3.0%,检出病原菌以假丝酵母菌属为主;留置导尿管标本78份,培养阳性40份,阳性率51.3%,发生导管相关性尿道感染8例,发生率为20.0%,检出病原菌以大肠埃希菌最常见;留置胃管标本55份,培养阳性47份,阳性率85.5%,检出病原菌以铜绿假单胞菌、鲍氏不动杆菌为主,其中有9株病原菌与VAP的病原菌一致。结论不同留置导管病原菌的感染率、种类不同,临床工作中对不同的导管及可能发生的相关感染应采取针对性的预防措施和不同的治疗方案。

OBJECTIVE To analyze the microbial colonization of various catheters （including endotracheal catheter, deep venous catheters, indwelling catheter and indwelling gastric tube） and the associated infections in the patients of medical intensive care unit （MICU） so as to provide basis for the prevention of nosocomial infections. METHODS The various catheters and the clinical specimens obtained from the patients of MICU from Sep 2009 to May 2010 were cultured, and the results of the culture were analyzed according to the clinical data. RESULTS Of totally 224 specimens cultured, there were 58 specimens of endotracheal catheters, among which 35 specimens were cultured positive with the positive rate of 94.8% ; the VAP occurred in 17 cases with the incidence rate of 29.3%; Acinetobacter baumannii was the most prevalent colonized bacteria, Pseudomonas aeruginosa was the main pathogen causing infections; there were 33 deep venous catheter specimens, among which 5 cases were cul tured positive, the catheter-related bloodstream infection occurred in 1 case with the incidence of 3.0%, and the Candida were the predominant pathogens isolated ; there were 78 indwelling catheter specimens with 40 speci- mens cultured positive, the positive rate was 51.3%, and the catheter-related urinary tract infections occurred in 8 cases with the incidence of 20.0%, and the Escherichia coli was the most common colonized bacteria and was the most prevalent bacteria causing infections; there were 55 indwelling gastric tube specimens with 47 specimens cul tured positive, the positive rate was 85.5% , and A. baumannii and P. aeruginosa were the predominant patho gens isolated ,among which there were 9 strains of pathogens that were as same as the pathogens causing VAP. CONCLUSION The different indwelling catheters vary in the microbial colonization rate, the colonized species, and the species causing infections. It is necessary to take targeted prevention measures and treatment programs for the various catheter-related infections.