NICU患者感染病原菌分布与耐药性分析

Distribution and drug resistance of pathogens causing infections in the NICU patients

目的分析神经重症监护病房(NICU)患者感染的病原菌分布与耐药性,为临床抗菌药物的合用应用提供参考依据。方法调查医院2012年2月-2015年2月NICU 216例重症患者的临床资料,对感染患者的病原菌分布及其耐药性进行统计分析;药敏试验采用K-B纸片扩散法。结果 216例重症患者中共83例发生感染,感染率38.43%;感染部位以呼吸系统为主,占49.40%,其次为泌尿系统和消化系统,分别占25.30%和13.25%;共分离出病原菌95株,其中革兰阳性菌20株占21.05%,以金黄色葡萄球菌为主,革兰阴性菌66株占69.48%,以肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌为主,真菌9株占9.47%,以白色假丝酵母菌为主;革兰阳性菌对哌拉西林/他唑巴坦、利奈唑胺、克林霉素、磺胺甲噁唑/甲氧苄啶、万古霉素等抗菌药物较敏感,革兰阴性菌对亚胺培南较敏感。结论 NICU感染率较高,病原菌以革兰阴性菌为主,根据药敏结果合理选择抗菌药物,可有效降低医院感染率。

OBJECTIVE To observe the distribution and drug resistance of the pathogens causing infections in the patients of neurosurgery intensive care unit （NICU ） so as to provide guidance for reasonable clinical use of antibi‐otics .METHODS The clinical data of 216 critically ill patients who were treated in the NICU from Feb 2012 to Feb 2015 were investigated ,then the distribution and drug resistance of the pathogens causing infections were statisti‐cally analyzed ,and the drug susceptibility testing was performed with the use of K‐B disk diffusion method . RESULTS The infections occurred in 83 of 216 critically ill patients with the infection rate of 38 .43% ,of whom 49 .40% had the respiratory system infections ,25 .30% had the urinary system infections ,and 13 .25% had the digestive system infections .A total of 95 strains of pathogens have been isolated ,including 20 （21 .05% ） strains of gram‐positive bacteria ,66 （69 .48% ） strains of gram‐negative bacteria ,and 9 （9 .47% ） strains of fungi;the Staphylococcus aureus was the predominant species of gram‐positive bacteria ,the Klebsiella pneumoniae ,Acine‐tobacter baumannii ,and Pseudomonas aeruginosa were dominant among the gram‐negative bacteria ,and the Can‐dida albicans was the major species of the fungi .The gram‐positive bacteria were highly susceptible to piperacillin‐tazobactam ,linezolid ,clindamycin ,trimethoprim‐sulfamethoxazole ,and vancomycin;the gram‐negative bacteria were highly susceptible to imipenem .CONCLUSION The incidence of infections is high in the NICU ,and the gram‐negative bacteria are dominant among the pathogens .It is an effective way to reasonably use antibiotics based on the results of the drug susceptibility testing so as to reduce the incidence of nosocomial infections .