急诊ICU患者感染病原菌特点及危险因素分析

Pathogenic characteristics and risk factors of emergency ICU infection patients

目的探讨急诊ICU患者感染病原菌特点及危险因素。方法选取于2015年2月-2016年9月医院ICU内患者180例作为研究对象,对感染患者相应部位取样进行病原学分析和药敏试验,收集患者的临床资料,评估导致感染发生的危险因素。结果 180例患者共出现感染58例,感染率为32.22%,共分离致病菌75株,其中革兰阴性菌31株占41.33%,以大肠埃希菌、肺炎克雷伯菌为主;革兰阳性菌44株占58.67%,以金黄色葡萄球菌、表皮葡萄球菌为主。表皮葡萄球菌对青霉素耐药率75.00%、磺胺甲噁唑耐药率83.33%等具有较强的耐药性,而对替考拉宁、万古霉素等具有较强的敏感性。金黄色葡萄球菌对青霉素耐药率100.00%、阿奇霉素耐药率52.17%等具有较强耐药性,对万古霉素、替考拉宁等具有较强敏感性。革兰阴性菌中大肠埃希菌及肺炎克雷伯菌对头孢唑林耐药率均为100.00%、阿莫西林耐药率均为100.00%等具有较强耐药性,而对头孢哌酮舒巴坦、美罗培南耐等具有较强敏感性。复合外伤、昏迷、格林巴利综合征、重症肌无力、泌尿道插管、动静脉插管、呼吸机使用为导致感染发生的独立危险因素。结论急诊ICU患者院内感染发生率较高,且多为多药耐药菌感染,临床治疗困难性较大,引起感染的危险因素较多,应采取有效措施尽量减少ICU内患者感染的发生。

OBJECTIVE To explore the pathogenic characteristics and risk factors of emergency ICU infection patients.METHODS A total of 180 patients in ICU of hospital from Feb.2015 to Sep.2016 were selected as the research subjects.The corresponding parts of the infected patients were sampled and analyzed for pathogens and drug sensitivity test.Clinical data of patients were collected to assess the risk factors for infections.RESULTS Totally 58 cases were infected in the 180 cases,and the infection rate was 32.22%.Totally 75 strains of pathogenic bacteria were isolated,including 31 strains of gram-negative bacteria,accounting for 41.33%,which were mainly Escherichia coli and Klebsiella pneumoniae,and 44 strains of gram-positive bacteria,accounting for 58.67%,which were mainly Staphylococcus aureus and Staphylococcus epidermidis.Staphylococcus epidermidis had strong resistance to penicillin（resistant rate of 75.00%）and sulfamethoxazole（resistant rate of 83.33%）,and had strong sensitivity to teicoplanin and vancomycin.Staphylococcus aureus had strong resistance to penicillin（tesistant rate of 100%）and sulfamethoxazole（resistant rate of 52.17%）,and had strong sensitivity to vancomycin and teicoplanin.As for gram-negative bacteria,Escherichia coli and Klebsiella pneumoniae had strong resistance to cefazolin（resistant rate of 100%）and amoxicillin（resistanr rate of 100%）,and had strong sensitivity to cefoperazone sulbactam and meropenem.Composite trauma,coma,green Barre syndrome,myasthenia gravis,urinary catheterization,arteriovenous intubation and breathing machine were independent risk factors for infections.CONCLUSIONThe incidence of nosocomial infections is higher for patients in ICU,and most of them are multidrug-resistant bacteria infections,so clinical treatment is difficult.There were lots of risk factors of nosocomial infections.Effective measures should be taken to reduce the incidence of infections for patients in ICU.