EICU与非EICU院内感染病原菌差异的分析

Analysis of pathogenic difference of nosocomial infection between Emergency Intensive Care Unit and general ward

目的了解本院近18个月急诊重症监护病房(EICU)和非EICU患者院内感染病原体的分布差异及药敏差异。方法对急诊住院病房院内感染患者进行回顾性统计分析。结果 EICU调查例数为402例,医院感染发病率为23.88%;非EICU病房调查例数为1925例,医院感染发病率为5.30%。EICU分离出菌株259株,革兰氏阴性菌占73.36%,革兰氏阳性菌占15.06%,真菌占11.58%;非EICU分离出菌株193株,革兰氏阴性菌占65.28%,革兰氏阳性菌占21.76%,真菌占12.95%。EICU居前三位的病原菌分别为鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌;非EICU居前三位的病原菌分别为肺炎克雷伯菌、鲍曼不动杆菌、屎肠球菌。药敏显示,肺炎克雷伯菌对碳青霉烯类高度敏感,对喹诺酮类敏感率>70%;鲍曼不动杆菌对替加环素、头孢哌酮舒巴坦、阿米卡星的敏感率>70%。结论 EICU较非EICU有较高院感率;非EICU与EICU患者院内感染均以革兰氏阴性菌感染为主;鲍曼不动杆菌、肺炎克雷伯菌对大多数抗菌药物耐药。

Objective To investigate the pathogen distribution and drug resistance of nosocomial infection between Emergency Intensive Care Unit（EICU）and general ward in recent 18 months. Methods Patients with nosocomial infection in EICU and general ward of our hospital were retrospectively analyzed. Results A total of 96 patients developed nosocomial infection in 402 patients came from EICU with the rate of infection was 23.88%.A total of 198 patients developed nosocomial infection in 1925 patients came from the general ward with the rate of infection was 5.30%.A total of 193 strains in general ward and 259 strains in EICU were separated,the proportion of Gram negative bacteria,Gram positive bacteria and fungi was 73.36%,15.06% and 11.58% in EICU respectively.In general ward,the proportion of Gram negative bacteria,Gram positive bacteria and fungi was 65.28%,21.76% and 12.95% respectively.Among 259 strains of pathogenic bacteria in EICU,the top 3 was Acinetobacter baumannii,Klebsiella pneumonia and Pseudomonas aeruginosa respectively,and in general ward,the top 3 was Klebsiella pneumonia,Acinetobacter baumannii,Enterococcus faecom respectively.Drug sensitivity result showed,Klebsiella pneumoniae had a higher sensitivity rate of carbapenems and to quinolone sensitive rate more than 70%.Acinetobacter baumannii had higher sensitive rate of igecyline,cefoperazone/sulbactum and amikacin,the sensitive rates more than 70%. Conclusion EICU have a higher nosocomial infection rate than general ward.The Gram positive bacteria are the preddominant pathogens causing nosocomial infection both in the EICU and the emergency general ward.Acinetobacter baumannii,Klebsiella pneumoniae are resistant to most of the commonly used antibiotics.