ICU内获得性感染细菌谱的时间分布分析

Analysis of Bacterial Time Distribution of ICU-acquired Infections

目的系统性回顾中国医科大学附属盛京医院入住重症医学科(ICU)患者48 h后细菌谱的时间分布规律,为ICU内感染早期抗生素的应用提供临床参考。方法收集2012年1月至2013年3月期间于中国医科大学附属盛京医院ICU病房治疗的患者共1 330例,其中阳性细菌培养结果患者254例,共收集病原菌1 110株,排除入住ICU病房48 h内检出病原菌288株,同一患者培养出相同病原菌者共222株。最后纳入统计的病原菌为600株。结果 ICU内获得性感染率为19.1%,其中术后患者占74.3%,以腹部、脑外、骨科术后感染发生率最高。肺部感染占ICU内获得性感染的首位(40.3%),其次为血源性感染(25.3%),术后引流管内(14.2%)及尿管(7.3%)感染。入住ICU第1周内病原菌检出率最高,随着时间进展病原菌检出率逐渐降低。ICU病房内感染菌株以鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌及屎肠球菌为主,任何时间均以革兰阴性杆菌占主导地位(73.8%)。另外,第2周真菌感染率上升。结论 ICU内获得性感染的防治应以革兰阴性杆菌为主,随着ICU住院时间的延长,条件致病菌的比率逐渐上升,主要为非发酵菌。真菌感染在患者入住ICU第2周发生的可能性最大。

Objective To retrospectively analyze bacterial time distribution of ICU-acquired infections in Shengjing Hospital of China Medical Uni-versity,so as to provide reference for the early antibiotic use for ICU-acquired infections. Methods A total of 1 330 cases in ICU from Jan. 2012 to Mar. 2013 were collected,the bacterial culture was positive in 254 cases. A total of 1 110 strains were collected from all the patients. Excluding 288 strains which were detected within 48 hours of patients′admission in ICU and 222 strains which were repeatedly detected in the same patients,600 strains were finally enrolled in the statistical analysis. Results The rate of ICU-acquired infections was 19.1%. Postoperative infections accounted for 74.3%,most of which occurred after neurosurgeries,and abdominal,orthopedic operations. Pulmonary infection ranked the first in ICU-acquired infections,accounting for 40.3%,followed by blood stream infection（25.3%）,postoperative drainage infection（14.2%）and urinary tract infection （7.3%）. The rate of pathogenic bacteria detection was the highest in the first week of patients′admission in ICU,and was getting lower as time went by. Strains detected in ICU mainly were Bauman Acinetobacter,Pseudomonas aeruginosa,Klebsiella pneumonia and Enterococcus faecium,most of strains resulting in infections were gram negative bacilli throughout the time. In addition,the infection rate of fungi was increased at 2 weeks of pa-tients′admission in ICU. Conclusion The treatment of ICU-acquired infections should be targeted at gram negative bacilli. The detection rate of op-portunistic pathogens gradually increased with prolonged stay in ICU,most of which are non-fermentative bacteria. Fungi infections are most likely to occur at 2 weeks of patients′admission in ICU.