重症监护病房血管导管相关感染目标性监测和抗菌治疗分析

Targeted monitoring and antibiotic therapy of vascular catheter related infection in intensive care unit

目的探讨重症监护病房(ICU)血管导管相关感染发生情况、影响因素、病原菌分布及抗菌治疗方式等,为相关临床研究提供参考依据。方法选取2014年1月-2015年10月医院ICU临床收治的重症患者252例为研究对象,针对患者的感染情况、导致感染的影响因素、感染的病原菌分布、药敏试验结果及抗菌治疗效果进行调查研究。结果 ICU 252例患者中,发生血管导管感染44例,感染率为17.46%;年龄、格拉斯哥昏迷评分、住院时间、合并症种类、昏迷时间和感染史等因素是导致患者感染的影响因素;感染患者共检测出病原菌51株,其中革兰阴性菌36株占70.59%,革兰阳性菌11株占21.57%,真菌4株占7.84%;检出的主要革兰阴性菌对左氧氟沙星、氨苄西林的耐药率为100.00%,对哌拉西林、他唑巴坦的耐药率为0,检出的主要革兰阳性菌对左氧氟沙星、庆大霉素的耐药率为100.00%,对利福平、万古霉素的耐药率为0。结论 ICU血管导管相关感染情况较为严重,年龄、格拉斯哥昏迷评分、住院时间、合并症种类、昏迷时间和感染史等因素是导致患者感染的影响因素,在临床治疗过程中应根据患者的药敏试验结果实施针对性的治疗,可以显著提升临床综合疗效。

OBJECTIVE To investigate the occurrence,influencing factors,pathogenic bacteria distribution and antibiotic therapy of vascular catheter related infection in intensive care unit （IVU）,so as to provide references for the clinical research.METHODS A total of 252 severe patients in ICU admitted to the hospital from Jan.2014 to （Oct.2015 were chosen as the research object.The infection of the patients,influencing factors of the infection,pathogens causing the infection,results of antimicrobial susceptibility test and antibacterial effect were investigated and analyzed.RESULTS In 252 ICU patients,44 cases were with vascular catheter infection,and the infection rate was 17.46%.Age,Glasgow coma score,hospital stay,type of complication,duration of coma and infection history were the factors that caused infection.There were 51 strains of pathogenic bacteria detected,including 36 strains of gram negative bacteria,11 strains of gram-positive bacteria and 11 strains of fungi,accounting for 70.59%,21.57% and 7.84%,respectively.The resistant rates of main gram-positive bacteria to levofloxacin and ampicillin were 100.00%,and to piperacillin and tazobactam were 0.00%.The resistant rates of main gram-negative bacteria to levofloxacin and gentamicin were 100.00%,and to to rifampicin and vancomycin were 0.CONCLUSION In intensive care unit,the incidence of vascular catheter related infection is serious.Age,Glasgow coma score,length of stay,type of complication,coma time and infection history are factors for infection in patients.It should be based on the susceptibility test results to take targeted therapy in clinical treatment,which can significantly enhance the clinical efficacy.