抗菌药物优化组合预防ICU患者医院感染研究

Antibiotics combination application for infection prevention in hospital ICU patients

目的分析不同的抗菌药物组合预防ICU患者医院感染的临床疗效,为临床应用提供理论依据。方法选择2010年5月-2014年4月医院600例ICU患者,按照随机数字表法均分为试验组、对照组1与对照组2。试验组静脉滴注阿米卡星与万古霉素,对照组1静脉滴注舒巴坦/氨苄西林、头孢唑林;对照组2静脉滴注哌拉西林、苯唑西林。观察3组ICU患者发生医院感染的例数。结果静脉滴注抗菌药物后,试验组感染6例（3.0%）;对照组1ICU感染35例（17.5%）;对照组2感染40例（20.0%）。经过检测发生医院感染的ICU患者分离病原菌230株,其中革兰氏阴性菌168株,鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌与大肠埃希菌占多数;革兰氏阳性菌30株,表皮葡萄球菌和金黄色葡萄球菌占多数;真菌32株。结论导致医院感染的细菌以革兰氏阴性菌居多,其次是革兰氏阳性菌和真菌。应用阿米卡星与万古霉素的试验组ICU患者发生医院感染的例数显著降低。

Objective To analyze the clinical efficacy of antibiotics in prevention of nosocomial infection in ICU and to provide theoretical basis for clinical use.Methods 600 cases in our hospital from May 2010 to April 2014 were randomly divided into experimental and control groups 1and 2.For experimental group amikacin and vancomycin were given intravenously.For control group1sulbactam/ampicillin,and cefazolin were given.For control group 2piperacillin and oxacillin were given.The cases of nosocomial infection were observed.Results After intravenous infusion of antibiotics,six cases of infection were found in the experimental group（3.0%）.While in the control group,230 infection pathogens were isolated,control group 1 35cases（17.5%）,control group 2 40cases（20.0%）;including 168gram-negative bacteria,Acinetobacter spp,Pseudomonas aeruginosa,Klebsiella pneumoniae and Escherichia coli bacteriain the majority;30Gram-positive bacteria,Staphylococcus epidermidis and Staphylococcus aureus,and 32 fungi.Conclusion The major causes of nosocomial infection were Gram-negative bacteria,followed by Gram-positive bacteria and Fungi.In the experimental group,nosocomial infections were significantly reduced after treated with vancomycin and amikacin.