Analysis on Distribution and Drug Resistance of Pathogenic Bacteria in ICU Patients with Nosocomial Infection from 2019 to 2021

Objective:To understand the pathogenic bacteria isolated from patients and their drug resistance changes in general ICU of the Affiliated Hospital of Hebei University,so as to provide reference for appropriate selection of antibiotics in clinical practice.Methods:A retrospective investigation was conducted to analyze the bacteriological distribution and drug resistance of nosocomial pathogens isolated from the specimens of hospitalized patients in the comprehensive ICU of the hospital from 2019 to 2021.The US technology BD Phoenix 100 automatic bacterial identification analyzer was used for bacterial identification of the pathogen samples,disk diffusion method was used for drug susceptibility test,and SPSS 22.0 software was used to analyze the trend of drug resistance.Results:A total of 970 strains of nosocomial pathogens were detected in the three years.The main pathogens were Acinetobacter baumannii(133 strains,13.71%),Klebsiella pneumoniae(106 strains,10.93%),Pseudomonas aeruginosa(83 strains,8.56%),Escherichia coli(76 strains,7.84%)and Enterococcus faecium(69 strains,7.11%).The resistance rate of Acinetobacter baumannii to antibiotics was high.Klebsiella pneumoniae,Pseudomonas aeruginosa and Escherichia coli had low resistance rates to carbapenems.The situation of bacterial drug resistance is still serious.Conclusion:The drug resistance of pathogenic bacteria collected from Class III Grade A Hospital’s patients to antibiotics was generally high.Therefore,clinical departments should strengthen the inspection of specimens of infection and drug sensitivity test in order to grasp the resistance mechanisms and drug resistance of pathogenic bacteria changes,and select appropriate antimicrobial agents according to the test results.Besides,the formation of drug-resistant strains also needs to be prevented,and the treatment of patients with severe infection needs to be improved.

Distribution and drug resistance of pathogens in burn patients in China from 2006 to 2019

BACKGROUND In this study,recent trends in the distribution and drug resistance of pathogenic bacteria isolated from patients treated at a burn ward between 2006 and 2019 were investigated.AIM To develop more effective clinical strategies and techniques for the prevention and treatment of bacterial infections in burn patients.METHODS Clinical samples with positive bacteria were collected from patients at the burn ward in Beijing Jishuitan Hospital in China between January 2006 and December 2019.The samples were retrospectively analyzed,the distribution of pathogenic bacteria was determined,and the trends and changes in bacterial drug resistance during different period were assessed.Drug resistance in several main pathogenic bacteria from 2006 to 2011 and from 2012 to 2019 was comparatively summarized and analyzed.RESULTS Samples from 17119 patients were collected and analyzed from 2006 to 2019.Surprisingly,a total of 7960 strains of different pathogenic bacteria were isolated at this hospital.Among these bacteria,87.98%(7003/7960)of the strains were isolated from burn wounds,and only 1.34%(107/7960)were isolated from the blood of patients.In addition,49.70%(3956/7960)were identified as Grampositive bacteria,48.13%(3831/7960)were Gram-negative bacteria,and the remaining 2.17%(173/7960)were classified as fungi or other pathogens.Importantly,Staphylococcus aureus(21.68%),Pseudomonas aeruginosa(14.23%),and Staphylococcus epidermidis (9.61%) were the top three pathogens most frequentlyisolated from patients.CONCLUSION In patients treated at the burn ward in this hospital from 2006 to 2019,Staphylococcus aureus and Pseudomonas aeruginosa were the predominant clinicalpathogens responsible for bacterial infections. The circumstantial detection anddetailed monitoring of the intensity and growth of different pathogenic bacteria inclinical patients as well as tests of drug sensitivity during burn recovery areparticularly important to provide guidelines for the application of antibiotics andother related drugs. Careful collection and correct, standard culture of bacterialspecimens are also crucial to improve the efficiency of bacterial infectiondetection. Effective monitoring and timely clinical treatment in patients may helpreduce the possibility and rate of infection as well as alleviate the effects of drugresistance among patients in burn centers.

Antibiotic sensitivity pattern of common bacterial pathogens in NICU and neonatal ward in Hamedan province of Iran

Bacterial pathogens and drug resistance are different in hospitals of each country. In this study we determined bacterial path- ogens and drug sensitivity in the neonatal ward and neonatal intensive care unit (NICU) in Ekbatan hospital in Hamedan. This cross-sectional descriptive study was done on 1150 hospitalized neonates in neonatal and NICU wards of Ekbatan hospital of the Hamadan university of medical sciences from September 2004 to September 2006. Blood, cerebrospinal fluid (CSF), urine, stool, eye excretion, synovial fluid, umbilical secretion and ascitic fluid were evaluated. Positive cultures were evaluated for antibiotic resistance with disk diffusion test methed. All of the data in questionnaires was analyzed with SPSS 13. Cultures including blood, urine, CSF , stool, eye excretion, synovial fluid, umbilical secretion and ascitic fluid was done in 417 neonates (833 cultures). These cultures were including: urine, 323 cases (38.8%) blood 293 cases (35.2%), CSF 180 cases (21.6%) , stool 17 cases (2%), eye secretion 16 cases (1.9%) and other secretions (synovial, umbilical, etc) 4 cases (0.5%). The cultures were positive in 105 cases (25.2%). 60 male neonates (57.1%) and 45 female neonates (42.9%) were culture positive. The most common microorganisms were E coli 66.7% (70 cases), Klebsiella 10.5% (11 cases). Drug resistance was high in these microorganisms. The most common microorganisms were Ecoli and klebsiella. Drug resistance was high in the isolated microorganisms.

Microbial spectrum and drug resistance of pathogens cultured from gallbladder bile specimens of patients with cholelithiasis:A singlecenter retrospective study

BACKGROUND Bacterial infection is an important cause of cholelithiasis or gallstones and interferes with its treatment.There is no consensus on bile microbial culture profiles in previous studies,and identified microbial spectrum and drug resistance is helpful for targeted preventive and therapeutic drugs in the perioperative period.AIM To analyze the bile microbial spectrum of patients with cholelithiasis and the drug susceptibility patterns in order to establish an empirical antibiotic treatment for cholelithiasis-associated infection.METHODS A retrospective single-center study was conducted on patients diagnosed with cholelithiasis between May 2013 and December 2018.RESULTS This study included 185 patients,of whom 163(88.1%)were diagnosed with gallstones and 22(11.9%)were diagnosed with gallstones and common bile duct stones(CBDSs).Bile culture in 38 cases(20.5%)was positive.The presence of CBDSs(OR=5.4,95%CI:1.3-21.9,P=0.03)and longer operation time(>80 min)(OR=4.3,95%CI:1.4-13.1,P=0.01)were identified as independent risk factors for positive bile culture.Gram-negative bacteria were detected in 28 positive bile specimens,and Escherichia coli(E.coli)(19/28)and Klebsiella pneumoniae(5/28)were the most frequently identified species.Gram-positive bacteria were present in 10 specimens.The resistance rate to cephalosporin in E.coli was above 42%and varied across generations.All the isolated E.coli strains were sensitive to carbapenems,with the exception of one imipenem-resistant strain.K.pneumoniae showed a similar resistance spectrum to E.coli.Enterococcus spp.was largely sensitive to glycopeptides and penicillin,except for a few strains of E.faecium.CONCLUSION The presence of common bile duct stones and longer operation time were identified as independent risk factors for positive bile culture in patients with cholelithiasis.The most commonly detected bacterium was E.coli.The combination ofβ-lactam antibiotics andβ-lactamase inhibitors prescribed perioperatively appears to be effective against bile pathogens and is recommended.Additionally,regular monitoring of emerging resistance patterns is required in the future.

Multi Drug Resistance Bacterial Isolates of Surgical Site Infection

Multi drug resistance microorganism is considered to be one of the major health problems. The aim of this study was to determine antibiotic susceptibility pattern of bacterial pathogens of surgical site infection. A total 250 samples were included, out of which 62.4% showed significant bacterial growth. Gram negative bacteria were 85.25% and gram positive bacteria were 14.75%;among them 65.38% of the total isolates were multi drug resistance (MDR). The age group between 31 - 40 found the highest number of isolates 22.4%. Among gram negative bacilli, the highest production of MDR was found in Acinetobacter spp. followed by Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli. In gram positive cocci, the highest production of MDR was found in Staphylococcus aureus. Acinetobacter spp. was found highly susceptible to amikacin and gentamycin 20.1% followed by ofloxacin and ciprofloxacin 18.6% and 16.2% respectively. Staphylococcus aureus showed 100% sensitive to clindamycin whereas penicillin showed 100% resistance followed by amoxycillin (93.75%). Amikacine and clindamycin were drugs of choice for gram negative and gram positive bacteria respectively. This study showed that alarming increase of infections was caused by multi drug resistance bacterial organisms. It increases length of stay and may produce lasting sequelae and requires extra resources for investigations, management and nursing care. Surveillance of surgical site infection is a useful tool to demonstrate the magnitude of the problem and find out appropriate preventive methods.

2021—2023年某三甲医院ICU病原菌分布及耐药性分析

目的:分析2021—2023年某三甲医院ICU病原菌分布及耐药性。方法:选取柳州市柳铁中心医院2021—2023年ICU各类送检标本中分离的1 581株病原菌作为研究资料,均行菌株鉴定和药敏试验。统计1 581株病原菌标本来源、类型、耐药性。结果:1 581株病原菌主要分离自下呼吸道标本,共分离1 195株(75.6%),类型主要是革兰阴性菌[1 200株(75.9%)],其次是革兰阳性菌[258株(16.3%)]和真菌[123株(7.8%)]。革兰阴性菌中,以鲍曼不动杆菌为主;革兰阳性菌中,以金黄色葡萄球菌为主。鲍曼不动杆菌对替加环素敏感性较高,敏感率>80%。对头孢类、β-内酰胺酶抑制剂类、碳青霉烯类、氨基糖苷类药物的耐药率均>80%。金黄色葡萄球菌对青霉素G耐药率>95%,对利奈唑胺、万古霉素、替考拉宁、替加环素和头孢洛林的耐药率均为0。结论:2021—2023年该院ICU病原菌感染以呼吸道感染为主,类型主要是革兰阴性菌,临床可对病原菌耐药性的变化进行实时监测,合理选用抗生素的同时控制和减少院内感染。

ICU感染病原菌分布情况及耐药性分析

目的:分析重症监护室(ICU)感染病原菌分布情况及耐药性。方法:回顾性分析2019年12月—2022年12月阜宁县人民医院收治的120例ICU患者的病例资料。统计ICU患者院内感染发生情况及病原菌分布特征,分析ICU院内感染患者耐药情况。结果:120例ICU患者共有30例发生院内感染,院内感染的发生率为25.00%。120例ICU院内感染患者共检出菌株35株,其中20株为革兰阴性菌,占病原菌总株数的57.14%,12株为革兰阳性菌,占病原菌总株数的34.29%,3株为真菌,占病原菌总株数的8.57%。对肺炎克雷伯菌、大肠埃希菌两种主要革兰阴性菌进行耐药性分析:肺炎克雷伯菌对头孢唑啉、左旋氧氟沙星、头孢吡肟的耐药率均>50.00%;肺炎克雷伯菌对亚胺培南、红霉素的耐药率最低,均为20.00%,对头孢唑啉的耐药率最高,为100.00%。大肠埃希菌对氨苄西林、莫西沙星的耐药率均≥50.00%;大肠埃希菌对亚胺培南的耐药率最低,为0,对氨苄西林的耐药率最高,为75.00%。对金黄色葡萄球菌、表皮葡萄球菌两种主要革兰阳性菌进行耐药性分析;金黄色葡萄球菌对氨苄西林、左旋氧氟沙星、红霉素的耐药率均>50.00%;表皮葡萄球菌对氨苄西林、红霉素的耐药率均为100.00%;金黄色葡萄球菌对莫西沙星的耐药率为0;表皮葡萄球菌对利福平的耐药率为0。结论:ICU患者检出病原菌以革兰阴性菌为主,多数病原菌存在不同程度的耐药,在临床治疗中需根据药敏结果有针对性地进行合理用药。

ICU呼吸道感染菌药敏与耐药感染危险因素及护理对策分析

目的 探究ICU呼吸道感染菌药敏与耐药感染危险因素,并分析其护理措施。方法 选取2022年1月至2023年12月我院ICU收治的87例患者,对所有患者进行药敏试验,观察ICU呼吸道感染病原菌及其耐药情况,分析耐药感染的危险因素以及对应护理措施。结果 ICU患者中感染患者21例(4.14%),共检出病原菌198株,以革兰阴性菌中大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌以及革兰阳性菌金黄色葡萄球菌为主。分析主要致病菌药敏情况,革兰阴性菌中大肠埃希菌对头孢唑林钠耐药性最高,肺炎克雷伯菌、鲍曼不动杆菌对阿莫西林/克拉维素具有较高耐药性,同时鲍曼不动杆菌对头孢唑林钠、氨曲南均有较高耐药性。革兰阳性菌中金黄色葡萄球菌主要对替考拉宁、青霉素、头孢唑林钠具有较高耐药性。单因素分析显示,年龄≥60岁、糖尿病、机械通气、入ICU前使用3种以上抗菌药物、入住ICU时长≥2周、APACHE-Ⅱ≥24分增加患者耐药感染风险(P <0.05)。结论 ICU呼吸道感染菌同时存在多株致病菌,风险因素较多,临床护理中需予以重视,严格按要求和规范护理,降低风险。

主动全覆盖筛查与预先接触隔离联用于ICU多重耐药菌防控中的效果观察

目的研究主动全覆盖筛查与预先接触隔离联用于ICU多重耐药菌感染防控中的效果。方法选取2021年8月至2022年7月所有入住ICU医疗单元的患者400例为对照组,2022年8月至2023年6月所有入住ICU医疗单元的患者400例为试验组,对照组执行常规多重耐药菌筛查与接触隔离程序,试验组执行主动全覆盖筛查与预先接触隔离联用管理模式,对2组干预后的各观察指标进行比较。结果试验组ICU医护人员多重耐药菌感染防控知信行评分高于对照组,多重耐药菌感染发生率低于对照组,CRE感染占比率高于对照组,差异均有统计学意义(P<0.05),主动全覆盖筛查的多重耐药菌敏感度为93.33%、特异度为99.00%。结论主动全覆盖筛查在多重耐药菌携带者早期识别领域应用价值较高,主动全覆盖筛查与预先接触隔离联用模式利于提升ICU医护人员的多重耐药菌感染防控知信行水平,可减低ICU住院患者多重耐药菌感染发生概率。

江西省某三甲医院2012—2020年ICU病房细菌耐药性监测

目的研究南昌大学第一附属医院2012—2020年ICU细菌感染的病原菌分布及耐药性,为抗菌药物合理使用提供数据支持。方法回顾性分析南昌大学第一附属医院2012—2020年ICU送检标本的微生物培养结果,采用Vitek 2 Compact全自动微生物检测系统进行菌种鉴定和药物敏感性分析,补充药敏试验采用纸片扩散法(K-B法)或E-Test法进行。结果2012—2020年南昌大学第一附属医院ICU科室共分离22064株病原菌,其中革兰阴性菌占79.9%,革兰阳性菌占20.1%;革兰阴性菌以鲍曼不动杆菌(22.4%)、肺炎克雷伯菌(18.7%)、铜绿假单胞菌(10.7%)为主,阳性菌以金黄色葡萄球菌(4.8%)、表皮葡萄球菌(3.5%)、屎肠球菌(2.4%)为主;病原菌主要分离自神经外科ICU(30.8%)、综合ICU(22.7%)和急诊科ICU(12.0%),以呼吸道(68.6%)、血液(13.1%)及尿液标本来源为主(5.6%);耐药性监测结果显示,耐碳青霉烯类鲍曼不动杆菌、耐碳青霉烯类肺炎克雷伯菌、耐碳青霉烯类铜绿假单胞菌及耐碳青霉烯类大肠埃希菌的检出率依次为87.2%、45.6%、49.2%、13.6%,耐苯唑西林金黄色葡萄球菌和耐苯唑西林表皮葡萄球菌检出率分别为50.1%和86.8%,革兰阴性菌对替加环素菌保持较高的敏感性,革兰阳性菌对万古霉素、利奈唑胺、奎奴普丁/达福普汀保持较好的敏感性;不同ICU科室抗菌药物耐药情况存在差异,烧伤科ICU病原菌耐药率明显高于其他科室,常见革兰阴性菌碳青霉烯类耐药率呈现渐变上升趋势。结论ICU分离的病原菌以革兰阴性杆菌为主且对抗菌药物耐药率日益增加,不同科室ICU设置会导致病原菌耐药性存在差异,易促进多重耐药菌的产生及流行。需加强不同ICU病区的细菌耐药监测,制定合理的抗感染方案并加强院感防控措施。

呼吸科ICU患者下呼吸道感染病原菌分布及耐药性分析

目的了解下呼吸道感染患者相关病原菌分布情况及耐药性,探讨预防重症监护室(ICU)患者医院下呼吸道感染的对策,从而降低ICU患者医院感染率。方法收集呼吸科2020年1月至12月符合下呼吸道感染ICU患者的痰标本,采用痰涂片镜检评估标本质量,合格标本培养分离主要病原菌并进行药物敏感试验,对试验结果进行统计分析。结果共检出病原菌153株,革兰阳性菌24株(15.7%),以金黄色葡萄球菌为主,占革兰阳性菌的95.8%,对奎奴普丁/达福普汀、利奈唑胺、万古霉素、替加环素、利福平的敏感性较高;革兰阴性菌129株(84.3%),前五位分别为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌和嗜麦芽窄食单胞菌,其中以多重耐药的鲍曼不动杆菌为主,对多粘菌素、替加环素敏感性高,铜绿假单胞菌对替卡西林/克拉维酸、左氧氟沙星、环丙沙星、妥布霉素耐药率较高。大肠埃希菌和肺炎克雷伯菌对碳青霉烯类、β内酰胺类联合酶抑制剂及氨基糖苷类抗生素敏感度高。结论我院呼吸科ICU患者下呼吸道感染以革兰阴性菌为主,主要为鲍曼不动杆菌,而且多数菌株呈现多重耐药性。临床应针对患者的高危因素,早期采取感染防控措施,预防耐药菌的传播。

ICU多重耐药菌感染患者血SAA、PCT、Treg细胞因子表达变化及治疗指导价值

目的 探讨ICU多重耐药菌(MDRO)感染患者血淀粉样蛋白A(SAA)、降钙素原(PCT)、调节性T细胞(Treg)因子表达变化及治疗指导价值。方法 选取2018年6月至2021年6月ICU MDRO感染患者68例为感染组,同期ICU未感染患者68例为对照组。比较2组一般资料、血清SAA、PCT、Treg细胞有关因子[转化生长因子-β(TGF-β)、白介素-17A(IL-17A)]水平,Logistic回归模型分析ICU MDRO感染的影响因素,分析感染组不同效果患者抗生素治疗前后血清SAA、PCT、TGF-β、IL-17A水平,以受试者工作特征曲线(ROC)分析各指标对抗生素治疗疗效的评估价值。结果 感染组入住ICU时间≥30 d、抗生素应用数量≥3种、呼吸机应用时间≥14 d、静脉置管时间≥14 d、留置导尿管时间≥14 d占比均高于对照组(P<0.05);感染组血清SAA、PCT、IL-17A水平高于对照组,血清TGF-β水平低于对照组(P<0.05);血清SAA、PCT、TGF-β、IL-17A均与ICU MDRO感染的发生显著相关(P<0.05);感染组抗生素治疗后不同疗效患者血清SAA、PCT、IL-17A水平均低于治疗前,血清TGF-β水平均高于治疗前,且有效患者各指标水平变化更明显(P<0.05);治疗前与治疗7 d后血清SAA、PCT、TGF-β、IL-17A水平差值评估抗生素治疗疗效的曲线下面积(AUC)分别为0.836、0.800、0.827、0.838,各指标差值联合评估的AUC最大,为0.911。结论 ICU MDRO感染患者血清SAA、PCT及Treg细胞有关因子IL-17A水平明显上调,TGF-β水平降低,抗感染治疗过程中动态监测各指标变化情况可辅助临床评估治疗效果,具有推广应用价值。

ICU护士多重耐药菌感染防控中知信行模式的应用效果

目的对ICU护士多重耐药菌感染防控中,对知信行模式的应用效果、应用价值展开研究,为后续管理工作提供指导。方法选取2022年1—12月湖南省胸科医院ICU在编的28名护士,2022年1—6月为实施前,进行常规管理,2022年6—12月为实施后,进行知信行模式管理,对比实施前后管理效果。结果实施后,知信行问卷各项评分、感染防控行为依从性、感染相关积极态度情况、感染相关知识知晓情况均高于实施前,差异有统计学意义(P<0.05)。结论知信行模式实施后,多重耐药菌感染相关知识知晓、感染防控行为依从性得分、感染相关态度持有情况均得到显著提升,对多重耐药菌感染率的抑制具有积极意义,适合推广普及。

New determinants of prognosis in bacterial infections in cirrhosis

Despite major advances in the knowledge and management of liver diseases achieved in recent decades,decompensation of cirrhosis still carries a high burden of morbidity and mortality.Bacterial infections are one of the main causes of decompensation.It is very important for clinical management to be aware of the population with the highest risk of poor outcome.This review deals with the new determinants of prognosis in patients with cirrhosis and bacterial infections reported recently.Emergence of multiresistant bacteria has led to an increasing failure rate of the standard empirical antibiotic therapy recommended by international guidelines.Moreover,it has been recently reported that endothelial dysfunction is associated with the degree of liver dysfunction and,in infected patients,with the degree of sepsis.It has also been reported that relative adrenal insufficiency is frequent in the non-critically ill cirrhotic population and it is associated with a higher risk of developing infection,severe sepsis,hepatorenal syndrome and death.We advise a change in the standard empirical antibiotic therapy in patients with high risk for multiresistant infections and also to take into account endothelial and adrenal dysfunction in prognostic models in hospitalized patients with decompensated cirrhosis.

Unresolved issues in the prophylaxis of bacterial infections in patients with cirrhosis

Bacterial infections are highly prevalent and a frequent cause of hospitalization and short-term mortality in patients with cirrhosis. Due to their negative impact on survival, antibiotic prophylaxis for bacterial infections in high-risk subgroups of patients with cirrhosis has been the standard of care for decades. Patients with prophylaxis indications include those at risk for a first episode of spontaneous bacterial peritonitis(SBP) due to a low ascitic fluid protein count and impaired liver and kidney function, patients with a prior episode of SBP and those with an episode of gastrointestinal bleeding. Only prophylaxis due to gastrointestinal bleeding has a known and short-time duration. All other indications imply longlasting exposure to antibiotics-once the threshold requirement for initiating prophylaxis is met-without standardized criteria for re-assessing antibiotic interruption. Despite the fact that the benefit of antibiotic prophylaxis in reducing bacterial infections episodes and mortality has been thoroughly reported, the extended use of antibiotics in patients with cirrhosis has also had negative consequences, including the emergence of multi-drug resistant bacteria.Currently, it is not clear whether restricting the use of broad and fixed antibiotic regimens, tailoring the choice of antibiotics to local bacterial epidemiology or selecting non-antibiotic strategies will be the preferred antibiotic prophylaxis strategy for patients with cirrhosis in the future.

ICU血流真菌感染的菌群分布及耐药性分析

目的:监测我院ICU血流真菌感染的菌种分布和耐药情况,为临床合理用药提供依据。方法:收集我院ICU2010年1月至2012年12月送检病原学标本,其中包括全血和导管血标本。所有标本先用BDBACTEC9120/9240全自动血培养仪进行培养,出现阳性报警后接种血平板、麦康凯、巧克力板、沙保弱培养基对病原菌进行分离,其中真菌鉴定采用科玛嘉念珠菌显色培养基及VITEK2-compact鉴定仪的YST卡进行菌种的鉴定,药敏试验采用纸片琼脂扩散法(K-B法)。结果:22653份血培养共分离出真菌60株,分离率0.26%,其中白念珠菌20株(33.33%),近平滑念珠菌12株(20.00%),热带念珠菌10株(16.67%),光滑念珠菌6株(10.00%),对氟康唑的耐药率分别为:3.1%、2.3%、8.7%和56.8%,对两性霉素B和伏立康唑均较敏感。结论:ICU血流真菌感染的病原菌以白念珠菌为主,光滑念珠菌对氟康唑的敏感率较低,尚未发现对两性霉素B和伏立康唑耐药的菌株。

ICU院内感染流行菌株及耐药情况

目的 了解ICU院内感染的流行菌株及菌株耐药 ,为临床防治提供依据。方法 对温州医学院附属第一医院ICU2 0 0 2年 7月～ 2 0 0 3年 6月所有分离的细菌菌株、真菌菌株及菌株耐药性进行回顾性调查。结果 共检出菌株 170例 ,其中G-菌 95例 (占 5 5 9% ) ,以铜绿假单胞菌、洋葱假单胞菌、鲍曼不动杆菌为主 ,主要见于呼吸道感染 ;G+ 菌 36例 (占 2 1 2 % ) ,以肠球菌和葡萄球菌为主 ,前者主要见于泌尿道和消化道感染 ,后者均见于呼吸道 ;真菌 38例 (占 2 2 4 % ) ,以白色念球菌为主 ,主要见于泌尿道感染。其细菌对常用抗菌药耐药严重 ,呈多重耐药 ,真菌耐药率尚低。结论 加强室内外环境和空气监控 ,防止交叉感染 ,侵入性操作要严格无菌操作 ,在积极治疗原发病的基础上加强支持疗法 ,增强机体免疫能力 ,严格掌握抗生素使用原则 ,根据药敏选用抗生素 ,避免长期大量联合用药 ,减少抗生素使用率 。

综合ICU一起疑似鲍曼不动杆菌感染暴发的调查

目的分析重症监护病房(ICU)多重耐药鲍曼不动杆菌(AB)医院感染暴发流行的流行病学特征,为医院感染预防与控制提供依据。方法采用流行病学调查和环境卫生学监测的方法调查2015年4月1日—26日入住某院ICU后发生肺部感染的患者,分析各种危险因素并采取相应的预防控制措施。结果先后共发生15例泛耐药AB医院获得性下呼吸道感染。15例患者共分离AB15株。1、3、4、5号患者检出AB药敏结果相同;6、7、8、9号患者检出AB药敏结果相同;10、11号患者检出AB药敏结果相同;时间均相对集中。共采集43份环境表面和医务人员手标本,床头柜AB检出率为100.00%(1/1),监护仪按钮为75.00%(6/8)、医务人员手为66.67%(4/6),治疗桌、输液泵按钮、医生鼻拭子均未检出AB。至2015年5月下旬综合ICU内未再出现类似新发病例。结论此次AB医院感染可能通过ICU环境表面和医务人员手播散,患者检出的AB呈广泛耐药性,积极治疗患者和采取严格的消毒隔离措施,可有效控制进一步流行。

综合性ICU院内感染细菌的分布情况及合理使用抗生素前后多重耐药菌变化情况

目的 探究并分析综合性ICL院内感染细菌的分布情况及合理使用抗生素前后多重耐药菌变化情况.方法 收集自2012年8月至2013年8月邯郸市第一医院2个ICL病房存在的菌株125株,并进行细菌培养及菌株鉴定,将其中菌株数比重最多的两种菌株作为研究对象,采用几种临床常见抗生素对其进行病原微生物耐药性检查.结果 125株病原菌中以铜绿假单胞菌最多,为43株（34.4％）,其次为大肠埃希菌为25株（20％）.铜绿假单胞菌和大肠埃希菌对不同抗生素类药的耐药率从2％～ 100％不等,且两种病原菌对同一种抗生素药物的耐药性差异均有统计学意义（P＜0.05）.结论 铜绿假单胞菌和大肠埃希菌在ICL感染病菌中较为常见,两种细菌对几种常用的抗生素均具有一定的耐药性,应用抗生素治疗前应先了解该菌的耐药性情况.

内科ICU和呼吸科病房临床分离菌的变迁及耐药性监测研究

目的研究我院内科ICU和呼吸科病房临床分离细菌的分布和细菌耐药性变迁。方法收集2002～2006年我院内科ICU和呼吸科病房送检的所有标本的细菌培养和药物敏感试验结果。结果共收集分离菌753株,以革兰氏阴性菌为主。肺炎链球菌对青霉素的耐药率为33%～67.8%,对左氧氟沙星的耐药率为26.3%～30.1%;肠杆菌科细菌和鲍曼不动杆菌对亚胺培南高度敏感;金葡菌中MRSA达74.5%,5年中呈增加趋势;未发现耐万古霉素的金葡菌和肠球菌。产ESBL大肠埃希菌株分离率为32.4%～36.8%,肺炎克雷伯菌为15.7%～18.3%;2006年铜绿假单胞菌敏感率在60%以上的药物依次为头孢他啶89%、阿米卡星84.3%、左氧氟沙星68.2%、亚胺培南69.3%、哌拉西林他唑巴坦70.3%、头孢吡肟67.7%。结论我院内科ICU和呼吸科病房临床分离菌及细菌耐药性的变迁符合国内细菌耐药性变化的总体趋势,与患者基础疾病、病情严重程度和用药史等因素有关,对抗菌药物的选用具有指导意义。