重症监护室血流感染患者常见细菌分布及药敏分析

An Analysis of Common Bacteria Distribution and Drug Sensitivity in Patients with Bloodstream Infection in Intensive Care Unit

目的通过对我院重症监护室(RICU、EICU、NICU、CCU)血流感染患者细菌的分布及耐药情况的了解,为临床合理使用抗菌药物、降低重症患者死亡率提供科学依据。方法选取我院2018年至2020年期间重症监护室送检的640份血培养阳性标本,针对标本中细菌的分布和药敏情况进行分析,了解不同细菌的耐药性。结果640份血培养阳性样本中,分离得到细菌581株,阳性率为90.8%,其中革兰阳性球菌292株(45.6%),革兰阴性杆菌289株(45.2%);真菌59株,阳性率为9.2%。革兰阳性球菌以葡萄球菌和肠球菌为主,对替加环素、利奈唑胺、万古霉素敏感率较高,耐万古霉素屎肠球菌5株;革兰阴性杆菌以大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌为主,对阿米卡星、亚胺培南、美罗培南、哌拉西林/他唑巴坦敏感率较高。结论我院重症监护室血流感染患者革兰阳性球菌与阴性杆菌病原体分离率相当,临床科室应加强对重症监护室血液培养的重视,定期对血流感染细菌分布特点和耐药情况进行回顾性分析。

Objective By investigating the distribution of bacteria and drug resistance in patients with bloodstream infections in the Intensive Care Unit(RICU,EICU,NICU,CCU)of our hospital,to provide a scientific basis for the rational use of antibacterial drugs in clinical practice and the reduction of mortality in critically ill patients.Methods We selected 640 positive blood culture specimens submitted by patients in the Intensive Care Unit of our hospital from 2018 to 2020.and analyzed the distribution and drug sensitivity of bacteria in the specimen,so as to gain deeper understanding of the drug resistance of different bacteria.Results Among the 640 positive samples submitted for inspection,581 strains of bacteria were isolated,with a positive rate of 90.8%;59 strains of fungi,with a positive rate of 9.2%.Among the 581 strains of bacteria isolated,292 strains(45.6%)of Gram-positive cocci and 289 strains(45.2%)of Gram-negative bacilli were obtained.It was found that Gram-positive cocci were mainly Staphylococcus and Enterococcus,and maintained high sensitivity to tigecycline,linezolid,and vancomycin.Five strains of Vancomycin-resistant Enterococcus faecium were found;Among the Gram-negative bacilli,Escherichia coli,Klebsiella pneumoniae,and Enterobacter cloacae were the main strains,and maintained high sensitivity to amikacin,imipenem,meropenem,piperacillin/tazobactam.Conclusion The number of pathogens isolated from Gram-positive cocci and negative bacilli in patients with bloodstream infection in the Intensive Care Unit of our hospital is roughly the same.The clinical department should pay more attention to blood culture in the intensive care unit.The distribution characteristics and drug resistance of bloodstream infections should be retrospectively analyzed on a regular basis.