心脏重症监护室多重耐药菌感染临床特点及耐药性分析

Analysis of the clinical characteristics and drug resistance of patients with multidrug-resistant organisms in the coronary care unit

目的分析心脏重症监护病房(CCU)患者多重耐药菌(MDRO)感染的临床分布特点和耐药性,为医院MDRO预防和控制提供依据。方法采用回顾性方法,对2014年1月至2018年12月新疆医科大学第一附属医院CCU收治的发生MDRO感染的154例患者的临床资料和耐药性进行总结分析。结果154例患者共检出MDRO 202株,患者基础疾病主要为心功能不全(31.9%)、急性心肌梗死(22.7%)和心绞痛(12.3%),以并发高血压、糖尿病和肾功能不全为主,51例患者行气管插管或气管切开。MDRO感染部位主要为:呼吸道感染(67.5%),泌尿系统感染(22.7%)和消化道感染(3.2%)。革兰阴性菌占85.7%,前4位分别为:鲍曼不动杆菌(20.2%)、大肠杆菌(16.8%)、肺炎克雷伯菌(13.9%)和铜绿假单胞菌(5.4%)。革兰阳性菌占34.6%,主要为肠球菌和金黄色葡萄球菌。鲍曼不动杆菌对多黏菌素B最敏感,对含有β内酰胺酶抑制剂的复合制剂如头孢哌酮/舒巴坦的敏感性高。而大肠杆菌对替加环素、美罗培南和亚胺培南耐药率低。结论CCU患者MDRO感染率高,需加强病原菌的耐药性监测,合理应用抗菌药物。

Objective To analyze the clinical characteristics and drug resistance of multidrug-resistant organisms(MDRO)in the coronary care unit(CCU),so as to provide the basis of prophylaxis and treatment of MDRO.Methods The clinical data and drug resistance of 154 cases of patients with MDRO from January 2014 to December 2018 were retrospectively analyzed.Results Among the 154 patients with MDRO,most of cardiovascular diseases are congestive heart failure(31.9%),acute myocardial infarction(22.7%)and angina pectoris(12.3%),51 patients were received trachea intubation and tracheotomy.The main sites of infection were respiratory tract(67.5%),urinary tract(22.7%)and intestine tract(3.2%).202 strains of MDRO strains were detected,Gram-negative pathogens accounted for 85.7%,the first four gram-negative pathogens were Acinetobacter baumannii(20.2%),Escheriehia coli(16.8%),Klebsiella pneumoniae(13.9%)and P Aeruginosa(5.4%),respectively.And Gram-positive pathogens accounted for 34.6%,the main pathogens were Enterococcus and Staphylococcus.Acinetobacter baumannii was the most sensitive to polymyxin,the resistance rate of Escherichia coli to tegacycline,meropenem and imipenem was low.Conclusion High infection rate of MDRO was found in CCU patients,strengthening the monitoring of drug-resistant pathogens is critical for the prophylaxis and treatment of MDRO infection.