重症监护病房患者中心静脉导管相关性感染病原菌分布及耐药性分析

Distribution and drug resistance of pathogens from central venous catheter-related infections in ICU patients

目的探讨和分析重症监护病房患者中心静脉导管相关性感染病原菌分布特征及其耐药性。方法选取2015年1月~2016年12月,在余姚市人民医院重症监护病房行中心静脉导管的864例患者,分离培养重症监护病房患者的病原菌,采用自动细菌鉴定/药敏分析仪,对病原菌对抗菌药物的敏感性进行测定。并分别对重症监护病房患者中心静脉导管相关性感染的病原菌分布特征及其耐药性监测情况,以及诱发感染的相关危险因素进行统计和分析。结果 864例重症监护病房患者发生中心静脉导管相关性感染73例,感染率为8.45%(73/864)。共检出病原菌81株,其中革兰阳性菌49株占60.50%,革兰阴性菌29株占35.80%,真菌3株占3.70%。主要革兰阳性菌对青霉素、红霉素、克林霉素以及苯唑西林耐药性较高,其耐药率均>70%;对万古霉素、利奈唑胺、四环素较敏感;主要革兰阴性菌对头孢吡肟、哌拉西林、氨曲南以及庆大霉素耐药性较高,其耐药率均>70%;而对头孢哌酮/舒巴坦、亚胺培南、阿米卡星较敏感。年龄、置管部位、置管时间、应用双腔导管以及应用抗菌药物是重症监护病房中心静脉导管患者相关性感染的影响因素(P<0.05)。结论重症监护病房中心静脉导管相关性感染的病原菌分布以革兰阳性菌为主,且感染的发生与年龄、置管部位、置管时间、应用双腔导管、应用抗菌药物等因素相关,临床治疗过程中应根据病原菌分布特征,耐药特点及其危险因素进行综合性干预。

Objective To understand the distribution and drug resistance of pathogens from central venous catheter-related infections in ICU patients. Methods From January 2015 to December 2016, 864 patients with central venous catheters in ICU of Yuyao People′s Hospital were selected.Pathogenic bacteria were cultured, isolated and drug sensitivity tests were performed using an automatic bacterial identification/drug sensitivity analyzer.The distribution and drug sensitivity of pathogens as well as risk factors related to infections were analyzed. Results Out of 864 patients in ICU, 73 had central venous catheter-related infections, with the overall infection rate of 8.45%(73/864).A total of 81 strains of pathogens were isolated, including 49 strains(60.50%) of gram-positive bacteria, 29 strains(35.80%) of gram-negative bacteria, 3 strains(3.70%) of fungi.The predominant gram-positive bacteria were highly resistant to penicillin, erythromycin, clindamycin and oxacillin, with the drug resistance rate of over 70%;while were sensitive to vancomycin, linezolid and tetracycline.The major gram-negative bacteria were highly resistant to cefepime, piperacillin, aztreonam and gentamicin, with the overall resistance rate of over 70%;while were sensitive to cefoperazone/sulbactam, imipenem and amikacin.Age, catheter location, catheter detaining time, application of duallumen catheters,and antibiotics use were influencing factors for central venous catheter-related infections in ICU patients(P<0.05). Conclusions Gram-positive bacteria are predominant pathogens in central venous catheter-related infections in ICU patients.Age,catheter location and detaining time,double lumen catheter usage and the use of antibiotics are major influencing factors for infections.Therefore,the clinical treatment should be based on the distribution and drug resistance of the pathogens.