ICU患者中心静脉导管相关性感染病原菌与耐药性分析

Distribution and drug resistance of pathogens causing central venous catheter-related infections in ICU patients

目的：调查分析 ICU 中心静脉导管感染的相关性及其感染病原菌分布与耐药性，为临床预防治疗提供依据。方法选取医院2011年1月－2014年10月 ICU 922例中心静脉置管患者为研究对象，调查中心静脉导管感染发生相关性、感染病原菌分布及耐药性。结果922例中心静脉置管患者发生导管相关性感染78例，感染率8．5％；股静脉部位置管感染率明显高于锁骨下静脉置管与颈内静脉置管感染率，差异有统计学意义（P ＜0．05）；共分离鉴定出病原菌86株，革兰阳性菌占59．3％、革兰阴性菌占34．9％、真菌占5 ．8％；主要革兰阳性菌对青霉素、红霉素、克林霉素等较高耐药性，耐药率为76．9％～100．0％；鲍氏不动杆菌对头孢噻肟、庆大霉素、头孢吡肟、氨曲南和哌拉西林高度耐药，耐药率为66．7％～100．0％；铜绿假单胞菌对头孢吡肟和庆大霉素高度耐药，耐药率分别为81．8％和72．7％。结论 ICU 中心静脉导管相关性感染较高，感染病原菌以革兰阳性菌为主，临床应结合药敏试验结果，选用合理的抗菌药物，减少耐药菌株产生。

OBJECTIVE To investigate the distribution and drug resistance of pathogens causing the central venous catheter-related infections in the ICU patients so as to provide guidance for clinical prevention and treatment . METHODS A total of 922 patients who underwent the central venous catheterization in the ICU from Jan 2011 to Oct 2014 were recruited as the study objects ,then the distribution and drug resistance of the pathogens causing the central venous catheter-related infections were observed .RESULTS The catheter-related infections occurred in 78 of 922 patients ,with the infection rate of 8 .5% ;the incidence of infections was significantly higher in the fem-oral vein catheterization site than in the subclavian vein catheterization site and the jugular vein catheterization site , there was significant difference （P＆lt; 0 .05） .Totally 86 strains of pathogens have been isolated ,among which the gram-positive bacteria accounted for 59 .3% ,the gram-negative bacteria 34 .9% ,the fungi 5 .8% .The main gram-positive bacteria were highly resistant to penicillin ,erythromycin ,and clindamycin ,with the drug resistance rate ranging from 76 .9% to 100 .0% ;the Acinetobacter baumannii strains were highly resistant to cefotaxime ,genta-micin ,cefepime ,aztreonam ,and piperacillin ,with the drug resistance rate ranging from 66 .7% to 100 .0% ;the Pseudomonas aeruginosa strains were highly resistant to cefepime and gentamicin ,with the drug resistance rates of 81 .8% and 72 .7% ,respectively .CONCLUSION The incidence of the central venous catheter-related infections is high in the ICU ;the gram-positive bacteria are dominant among the pathogens .It is necessary for the hospital to reasonably use antibiotics based on the results of drug susceptibility testing so as to reduce the drug -resistant strains .