某院72例重症监护病房脓毒症患者的病原学检查结果及其对抗菌药物的耐药性分析

Analysis on Results of Etiology Examination and Resistance to Antimicrobial Agents in 72 Patients with Sepsis in ICU of a Hospital

目的:分析医院重症监护病房(ICU)脓毒症患者的临床特征、病原学检查结果及其对抗菌药物的耐药性。方法:抽取2016年1月-2018年1月间收治的ICU脓毒症患者72例资料,将其分为死亡组23例和存活组49例;统计其送检样本中病原菌种类和药敏试验结果,分析其致病菌的分布及其耐药性。结果:72例脓毒症患者的送检标本中,分离出166株病原菌,其中革兰阳性菌46株(27.71%)、革兰阴性菌104株(62.65%)和真菌16株(9.64%);革兰阳性菌中金黄色葡萄球菌对环丙沙星、氨苄西林、青霉素G与哌拉西林的耐药性均较高,而表皮葡萄球菌对氨苄西林、头孢他啶的耐药性较高;革兰阴性菌中大肠埃希菌对红霉素、复方磺胺甲噁唑、头孢哌酮的耐药性均较高,而铜绿假单胞菌对头孢曲松、复方磺胺甲噁唑、头孢哌酮与头孢西丁的耐药性均大于65%;存活组降钙素原、血乳酸两项指标测得值均低于死亡组(P<0.05),而其余指标测得值两组间比较其差异均无统计学意义(P>0.05)。结论:脓毒症患者所感染的病原菌主要为革兰阳性菌和革兰阴性菌,其中革兰阳性菌中的金黄色葡萄球菌和革兰阴性菌中的大肠埃希菌的耐药性均较高,在临床针对脓毒症患者的治疗应依据药敏结果合理选用抗菌药物治疗,以确保患者用药的有效性和安全性。

Objective:To analyze the clinical characteristics,the results of pathogenic examination and the resistance to antimicrobial agents in patients with sepsis in intensive care unit(ICU)of hospital.Methods:72 cases of ICU sepsis patients admitted from January 2016 to January 2018 were collected and divided into the death group(23 cases)and the survival group(49 cases).The types of pathogenic bacteria and drug susceptibility test results in the samples and the distribution of pathogenic bacteria and their drug resistance were analyzed.Results:166 strains of pathogenic bacteria were isolated from 72 patients with sepsis,including 46 strains of gram-positive bacteria(27.71%),104 strains of gram-negative bacteria(62.65%)and 16 strains of fungi(9.64%).Among the gram-positive bacteria,Staphylococcus aureus had higher resistance to ciprofloxacin,ampicillin,penicillin G and piperacillin,and Epidermis Staphylococcus aureus to ampicillin,cephalosporins resistance was higher.Among the gram-negative bacteria,the E.coli to erythromycin,compound sulfamethoxazole,cefoperazone resistance were higher,and Pseudomonas aeruginosa to ceftriaxone,compound sulfamethoxazole,cefoperazone and cefoxitin resistance were greater than 65%.The measured values of procalcitonin and serum lactic acid in the survival group were lower than those in the death group(P<0.05),while the measured values of other indicators were not statistically significant between the two groups(P>0.05).Conclusion:sepsis patients infected by the pathogen of mainly gram-positive bacteria and gram-negative bacteria,among them gram-positive bacteria Staphylococcus aureus and gram-negative bacteria in the drug resistance of E.coli was high;to conduct in the treatment of patients with clinical against sepsis should be according to the results of drug susceptibility,a reasonable choice of antimicrobial drugs,to ensuring the efficacy and safety of the patients in drug use.