急诊重症监护室病原微生物感染特点与细菌耐药性分析

Analysis of the characteristics of pathogenic microorganism infection and bacterial drug resistance in emergency intensive care unit

目的分析急诊重症监护室(EICU)病原菌感染特点及细菌耐药性,为合理使用抗菌药物,有效控制感染提供依据。方法收集洛阳市中心医院EICU 2015年1月至2016年12月收治628例患者中的214例感染患者送检的1 516份标本进行病原学检验及药物敏感性试验。分析标本构成比、病原学送检阳性率、病原菌构成比、病原菌感染特点、不同感染部位重点菌排序及细菌耐药情况。结果病原学送检阳性率为14.31%(217/1 516),剔除重复标本,有效阳性标本186株,其中革兰阴性菌123株(66.13%),真菌34株(18.28%),革兰阳性菌29株(15.59%);下呼吸道、泌尿系统及血液系统为最常见感染部位,分别检出87株(46.77%)、39株(20.97%)、32株(17.20%);社区感染比例(90.32%,168/186)显著高于医院感染比例(9.68%,18/186)(χ~2=80.778,P<0.05);各感染部位社区感染与医院感染病原菌排序不同,下呼吸道医院感染鲍曼不动杆菌及嗜麦芽窄食单胞菌比例增加,泌尿系医院感染检出粪肠球菌;大肠埃希菌及肺炎克雷伯菌对碳青霉烯类、β内酰胺酶抑制剂、阿米卡星、头孢西丁及头孢他啶耐药率较低,铜绿假单胞菌对喹诺酮类、头孢他啶、哌拉西林舒巴坦、氨基糖苷类及β内酰胺酶抑制剂耐药率较低,42.86%金黄色葡萄球菌为苯唑西林耐药金黄色葡萄球菌。结论 EICU患者下呼吸道、泌尿系统、血液系统感染为最常见感染部位;社区感染比例高于医院感染,呼吸机相关性肺炎、导尿管相关尿路感染、导管相关血流感染是常见的医院感染;各感染部位社区感染与医院感染病原菌排序与细菌耐药性不同,经验性选用抗菌药物需要覆盖常见病原菌。

Objective To analyze the characteristics of pathogenic microorganism infection and the bacterial drug resistance in emergency intensive care unit（ EICU）,and to provide the basis for rational use of antibacterials and effective control of infection. Methods A total of 1 516 samples of infected patients were collected from 214 infected patients who were diagnosed in 628 patients from January 2015 to December 2016 in EICU of the Central Hospital of Luoyang City. The specimens were subjected to etiological detection and drug sensitivity tests. The constituent ratio of samples,positive rate of etiological examination,the constituent ratio of pathogenic bacteria,the characteristics of pathogenic microorganism infection,the classification in different infection sites,the main bacteria in different infection sites and the bacterial drug resistance were analyzed. Results The positive rate of etiological examination was 14. 31%（ 217/1 516）,there were 186 effective positive specimens after removing duplicate samples,including 123 gram negative bacteria（ 66. 13%）,34 fungi（ 18. 28%） and 29 gram positive bacteria（ 15. 59%）. The lower respiratory tract,urinary tract and blood system were the most common sites of infection; there were87 strains（ 46. 77%）,39 strains（ 20. 97%） and 32 strains（ 17. 20%） were detected. The proportion of community infection（ 90. 32%,168/186） was significantly higher than that of nosocomial infection（ 9. 68%,18/186）（ χ^2= 80. 778,P〈0. 05）.There was difference in the main pathogenic bacteria in different infection sites between community infection and nosocomial infection,the proportion of Acinetobacter baumannii and Stenotrophomonas maltophilia in lower respiratory tract increased in the patients with nosocomial infection,the Enterococcus faecalis were detected in urinary tract infection in the patients with nosocomial infection. The Escherichia coli and Klebsiella pneumoniae have lower resistance to carbapenems,β-lactamase inhibitors,amikacin,cefoxitin and ceftazidime. The resistance rate of Pseudomonas aeruginosa to quinolone,ceftazidime,piperacillin and sulbactam,aminoglycosides and β-lactamase inhibitors was low. 42. 86% Staphylococcus aureus were oxacillin-resistant Staphylococcus aureus. Conclusion EICU patients with infection,lower respiratory tract,urinary tract and blood system were the most common infection site. The proportion of community infection is higher than that of nosocomial infection. The ventilator-associated pneumonia,urethral catheter-related urinary tract infection and catheter-related blood infection are common nosocomial infections. There are differences in the pathogenic bacteria and bacterial drug resistance in different infection sites between community infection and nosocomial infection. The common pathogens should be taken into account in the empirical selection of antimicrobial agents.