NICU亚低温治疗患者医院感染病原菌及耐药性分析

Distribution and drug resistance of pathogens causing nosocomial infections in NICU patients receiving mild hypothermia therapy

目的了解神经内科重症监护病房(NICU)亚低温治疗患者医院感染病原菌分布及耐药率,为临床合理使用抗菌药物、减少细菌耐药性提供参考。方法回顾性分析2009年10月-2012年9月入住NICU的238例经亚低温治疗患者临床资料,采用WalkAway96S1全自动细菌鉴定和药敏分析仪对菌株进行鉴定和药敏分析,所有结果均参照美国临床实验室标准化委员会(NCCLS)的指南进行判定;对所有数据采用SPSS17.0进行统计分析。结果 238例患者中发生医院感染57例,感染率23.95%,感染部位以呼吸道为主占57.89%,其次为泌尿道、皮肤、消化道,分别占14.04%、8.77%、7.02%;检出病原菌以革兰阴性菌为主58株占71.60%,其次为革兰阳性球菌占20.99%,真菌占7.41%,肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌3种主要革兰阴性菌对多种抗菌药物存在不同程度耐药,肺炎克雷伯菌和鲍氏不动杆菌对氨苄西林的耐药率为100.00%。结论神经重症亚低温治疗患者医院感染以呼吸道为主,病原菌以革兰阴性菌为主,其药敏试验呈现多药耐药性,临床应加强病原菌耐药监测,合理使用抗菌药物,改善患者的预后。

OBJECTIVE To investigate the distribution and drug resistance of pathogens causing nosocomial infec- tions in the patients who received mild hypothermia therapy in neurosurgical intensive care unit （NICU） so as to provide guidance for reasonable clinical use of antibiotics and reduction of bacterial drug resistance. METHODS The clinical data of 238 patients who underwent the mild hypotherrnia therapy in the NICU from Oct 2009 to Sep 2012 were retrospectively analyzed, then the identification of the strains was carried out bY using WalkAway96S1 auto- matic bacteria analyzer, the drug susceptibility testing was performed with the use of drug susceptibility analyzer, the results were interpreted based on the National Committee of Clinical Laboratory Standards （NCCLS）, and all the data were statistically analyzed by means of SPSS17.0 software. RESULTS Of the 238 patients, the infections occurred in 57 cases with the infection rate of 23.95 M, among whom the patients with respiratory tract infections accounted for 57. 89%, the patients with urinary tract infections 14. 04%, the patients with skin infections 8.77%, the patients with gastrointestinal tract infections 7.02%%. Among the isolated pathogens, there were 58 （71. 60%） strains of gram-negative bacteria, followed by the gram-positive cocci （20. 99M） and the fungi （7.41%）. Klebsiella pneurnoniae , Acinetobacter baumannii , and Pseudomonas aeruginosa were the predominant species of gram-negative bacteria and varied in the drug resistance to multiple antibiotics; the drug resistance rates of the K. pneumoniae and A. baurnannii to ampicillin were 100.00%. CONCLUSION The respiratory tract is the major infection site of the patients undergoing the mild hypothermia therapy; the gram-negative bacteria are the predominant pathogens and are multidrug-resistant. It is necessary for the clinician to strengthen the surveillance of drug resistance of the pathogens and reasonably use antibiotics so as to improve the prognosis of the patients.