心血管內科患者医院感染病原菌分布与耐药性分析

Distribution and drug resistance of pathogens causing nosocomial infections in patients of cardiovascular medicine department

目的探讨心血管内科医院感染患者病原菌分布及耐药特点,为心血管内科患者预防控制医院感染提供参考依据。方法查阅与分析心血管内科2013年1月-2014年12月收治的住院患者病历,药物监测与试验数据的读取原则遵循K-B法,药敏结果依据美国临床实验室标准化研究所标准进行判定,采用WHONET软件进行统计分析。结果 4 178例患者发生医院感染299例、365例次,感染率为7.2%、例次感染率为8.7%;感染部位以呼吸道、泌尿道感染最高,分别占62.7%、19.5%;分离出405株病原菌中革兰阴性菌占66.7%,革兰阳性菌占24.9%,真菌占8.4%;革兰阴性菌中产ESBLs菌检出率47.1%;耐碳青霉烯类铜绿假单胞菌和鲍氏不动杆菌检出率分别为22.2%和31.7%;革兰阳性菌中MRS检出率为50.6%;多数病原菌表现广泛耐药及严重耐药性,其中耐药率最高是磺胺类抗菌药物,均>65.0%。结论心血管内科疾病大多危及生命,抗感染时宜选择高敏感的药物,注重用药安全,降低细菌耐药性。

OBJECTIVE To explore the distribution and drug resistance of pathogens causing nosocomial infections in the patients of cardiovascular medicine department so as to provide guidance for prevention and control of the nosocomial infections in the cardiovascular medicine department patients.METHODS The medical records of the patients who were hospitalized from Jan 2013 to Dec 2014 were reviewed and analyzed.The data of surveillance of drugs and test were read based on the K-B method,the results of drug susceptibility testing were interpreted in accordance with the standards of Clinical and Laboratory Standards Institute,and the statistical analysis was performed with the use of WHONET software.RESULTS Of 4 178 patients,299had the nosocomial infections with the prevalence rate of 7.2% and the case-time infection rate 8.7%,of whom 62.7% had respiratory tract infections,and 19.5% had urinary tract infections.A total of 405 strains of pathogens were isolated,of which 66.7%were gram-negative bacteria,24.9% were gram-positive bacteria,and 8.4% were fungi.Among the isolated gramnegative bacteria,the detection rate of ESBLs-producing strains was 47.1%,the detection rates of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter spp were 22.2% and 31.7%,respectively.Among the isolated gram-positive bacteria,the detection rate of MRS was 50.6%.The majority of the pathogens showed pandrug-resistance and high drug resistance,and the drug resistance rate to sulfonamides was more than 65.0%.CONCLUSION Most of the cardiovascular diseases pose threats to the lives of patients.It is necessary to choose highly sensitive antibiotics for treatment of the infections and pay attention to the safety of medication so as to reduce the drug resistance.