综合ICU患者血流感染病原菌分布与耐药性的调查分析

目的调查综合ICU血流感染(BSI)的病原菌分布及药敏情况,为BSI患者的临床诊洽提供参考。方法收集2016年1月至2019年6月综合ICU血培养FR性患者临床特征、病原菌与定植污染菌分离情况以及主要病原菌药敏结果。结巣综合ICU血培养分离菌株337株,其中161株来源于确诊BSI患者,其余176株判定是定植或污染。161株中革兰阴性杆菌占59.01%,革兰阳性球菌占36.02%,念珠菌属占4.97%;药物敏感试验甲氧西林耐药凝固酶阴性葡萄球菌25株(86.21%)和金黄色葡萄球菌(MRSA)4株(40.0%),对万古霉素与利奈哇胺均敏感,检出碳青霉烯类耐药的肺炎克雷伯菌13株(38.24%)、鲍氏不动杆菌7株(87.5%)、铜绿假单胞菌4株(28.57%)。结论综合ICU血培养分离菌以革兰阴性杆菌为主,且耐药性较高;应重视疑似血流感染患者血培养送检和监测,以指导临床抗菌药物合理使用。

Objective To investigate the distribution and drug susceptibility of pathogens causing bloodstream infection(BSI)in ICU patients of grade three level A hospital,and to provide references for the clinical diagnosis and treatment of BSI patients in the future.Methods The clinical characteristics of patients with positive blood culture from January 2016 to June 2019 were investigated and analyzed,as well as the isolation status of pathogenic bacteria and colonized bacteria and pollution bacteria,as well as the drug susceptibility results of main pathogenic bacteria.Results During the investigation period,337 strains were isolated from the comprehensive ICU blood culture,of which 161 were&om patients diagnosed with BSI,while the remaining 176 were determined to be colonized or contaminated.Among 161 strains,59.01%were gram-negative bacilli,36.02%were grampositive cocci,and 4.97%were Candida.Drug sensitive test of benzene azole Westwood resistant,coagulase negative staphylococcus 25 strains(86.21%)and staphylococcus aureus(MRSA)4 strains(40%),both were sensitive to vancomycin.Detect Carbapenems resistance were 13 strains(38.24%)of Klebsiella pneumoniae,7 strains(87.5%)of Acinetobacter baumannii and 4 strains(28.57%)Pseudomonas Aeruginosa;Conclusion The isolated bacteria in comprehensive ICU blood culture are mainly gram-negative bacilli with high drug resistance.Attention should be paid to the blood culture and monitoring of suspected BSI patients to guide the rational use of clinical antibiotics.