ICU重症肝病患者医院感染病原菌分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria from nosocomial infections for patients with severe liver disease in ICU

目的了解重症监护病房(ICU)重症肝病患者医院感染病原菌的分布及其耐药性,为指导临床用药提供参考依据。方法收集2011年3月-2014年3月医院重症肝病患者的腹水、痰液、尿液以及血液标本,细菌培养后行药敏试验并分析其病原菌分布及耐药性,数据采用SPSS19.0软件进行统计分析。结果 113例重症肝病患者发生医院感染51例,感染率为45.13%,共分离出97株病原菌,其中革兰阳性球菌37株占38.13%,以金黄色葡萄球菌、表皮葡萄球菌为主,革兰阴性杆菌52株占53.62%,以大肠埃希菌、肺炎克雷伯菌为主,真菌8株占8.25%;标本来源主要为痰液、腹水、血液,分别占38.14%、25.78%、21.65%;金黄色葡萄球菌和表皮葡萄球菌对青霉素、头孢西丁耐药率>75.00%,对万古霉素和替考拉宁敏感性较强,大肠埃希菌和肺炎克雷伯菌对氨苄西林、磺胺甲噁唑/甲氧苄啶耐药率>60.00%,对亚胺培南的敏感性较强。结论重症肝病患者感染的病原菌以葡萄球菌属和大肠埃希菌为主,且耐药性较高,临床治疗时应合理选择抗菌药物。

OBJECTIVE To understand the distribution and drug resistance of pathogenic bacteria from nosocomial infections for patients with severe liver disease in ICU,so as to provide reference for clinical medication.METHODS Ascites,sputum,urine and blood samples from patients with severe liver disease in our ICU from Mar.2011 to Mar.2014 were collected,drug sensitive test was conducted after bacterial culturing,and the distribution and drug resistance of pathogens were analyzed.All data were analyzed by SPSS 19.0software.RESULTS Totally 51 of 113cases with severe liver disease occurred hospital infections（45.13%）,of the 97 strains of bacteria which were isolated.Among them,37 strains were gram-positive coccus（38.13%）,it mainly contained Staphylococcus aureus and Staphylococcus epidermidis;and 52cases（53.62%）were gram-negative coccus,which mainly included Escherichia coli,Klebsiella pneumoniae,and there were 8strains（8.25%）fungi.The samples were mainly from sputum（38.14%）,ascites（25.78%）and blood（21.65%）.S.aureus and S.epidermidis were resistant to penicillin,erythromycin and cefoxitin,the resistance rates were above 75.00%.And it had strong sensitivity to vancomycin and teicoplanin.The resistant rates of E.coli and K.pneumoniae to ampicillin,sulfamethoxazole/trimethoprim were above 60.00%,and it had strong sensitivity to imipenem.CONCLUSIONS S.aureus and E.coli are the main bacterial pathogens in patients with severe liver disease from ICU,and it has a characteristic of high drug resistance,so it should be chosen as drugs for clinical treatment.