ICU医院感染的病原菌分布及耐药性监测

Distribution and drug resistance surveillance of pathogens causing nosocomial infections in ICU

目的了解重症监护病房(ICU)医院感染的病原菌分布及其耐药性,为临床合理用药提供理论依据。方法回顾性分析2012年4月-2013年3月医院ICU住院患者的送检标本,严格按照操作规范对标本进行痰培养以及菌株鉴定,细菌药敏试验采用K-B纸片扩散法,按照美国临床实验室标准化研究所(CLSI)标准对药敏结果进行判定,采用Excel表格对数据进行汇总和分析。结果 ICU住院患者送检的标本来源主要为痰咽拭子占68.2%,其次为血液占15.0%;共分离出病原菌214株,其中革兰阴性菌143株占66.8%,革兰阳性菌28株占13.1%,真菌43株占20.1%;前4位革兰阴性菌分别为鲍氏不动杆菌、铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌,分离的革兰阴性菌大多具有多药耐药性,其中以鲍氏不动杆菌耐药最显著。结论 ICU感染的病原菌主要发生在呼吸道,以革兰阴性菌为主,且耐药较严重,临床上应及时留取标本进行细菌鉴定,并根据药敏结果合理用药,有效控制医院感染的发生。

OBJECTIVE To investigate the distribution and drug resistance of pathogens causing nosocomial infections in the intensive care unit （ICU ） so as to provide reliable theoretical evidence for the rational use of drug in clinical practice .METHODS The samples collected from patients hospitalized in the ICU of the hospital from Apr 2012 to Mar 2013 were retrospectively analyzed and the sample sputum culture and strain identification were strictly operated as per the work standards ;bacteria drug sensitivity test was conducted with Kirby-Bauer method , and the results were determined according to the standard of Clinical and Laboratory Standard Institute （CLSI） . Excellformat was adopted to summarize and analyze the relevant data .RESULTS The specimens collected from ICU patients were mainly from phlegm with throat swab predominantly accounting for 68 .2% and blood secondly accounting for 15 .0% .Of the 214 strains of pathogens ,143 strains of gram-negative bacteria accounted for 66 .8% ,28 strains of gram-positive bacteria accounted for 13 .1% and 43 strains of fungi accounted for 20 .1% . The top four isolated gram-negative bacteria were Acinetobacter baumannii ,Pseudomonas aeruginosa ,Escherichia coli and K lebsiella pneumoniae . Most of the isolated gram-negative bacteria had multiple drug resistance , thereinto ,A . baumannii had the most obvious drug resistance .CONCLUSIONS The pathogens causing ICU infection are mainly distributed in the respiratory tract with gram-negative bacteria predominant and having high drug resistance .It is necessary to preserve the samples for bacterial identification in time and to rationally use the drug according to the drug sensitivity test results in clinical practice so as to effectively control the nosocomial infections .