【摘要】：目的探討重癥監(jiān)護(hù)病房(ICU)及非ICU患者導(dǎo)管相關(guān)性血流感染(CRBSI)的發(fā)生、病原菌分布及其耐藥性,為其預(yù)防控制、合理使用抗菌藥物提供科學(xué)依據(jù)。方法對2013年1月-2014年12月醫(yī)院ICU及非ICU留置中央靜脈導(dǎo)管(CVC)的患者進(jìn)行前瞻性監(jiān)測,統(tǒng)一CRBSI診斷標(biāo)準(zhǔn)分析其臨床特點(diǎn)、病原菌構(gòu)成和藥物敏感試驗(yàn)結(jié)果。結(jié)果 2013年1月-2014年12月共監(jiān)測患者4 175例,累計(jì)中央靜脈置管日共38 984d,發(fā)生CRBSI 125例次,CRBSI感染率為3.21‰;共分離出病原菌131株,其中革蘭陰性菌74株占56.49%,革蘭陽性菌37株占28.24%,真菌20株占15.27%;主要的病原菌中耐甲氧西林凝固酶陰性葡萄球菌、耐碳青霉烯類肺炎克雷伯菌、產(chǎn)ESBLs大腸埃希菌、耐美羅培南銅綠假單胞菌檢出率分別為75.0%、23.5%、30.8%、33.3%;凝固酶陰性葡萄球菌對萬古霉素、利奈唑胺、替加環(huán)素、呋喃妥因的敏感率均為100.0%,銅綠假單胞菌對氨基糖苷類、喹諾酮類耐藥率低,均10.0%,熱帶念珠菌對伊曲康唑和氟康唑耐藥率為50.0%和25.0%。結(jié)論監(jiān)測ICU以及非ICU的CRBSI發(fā)生以及病原學(xué)變化,有助于進(jìn)一步加強(qiáng)有效的預(yù)防控制措施和提供早期的經(jīng)驗(yàn)性抗菌藥物治療方案。
[Abstract]:Objective to investigate the occurrence, distribution and drug resistance of catheter-associated blood flow infection (CRBSI) in patients with (ICU) and non-ICU in intensive care unit (ICU), and to provide scientific basis for its prevention and control and rational use of antibiotics. Methods from January 2013 to December 2014, patients with ICU and non-ICU indwelling central venous catheter (CVC) were monitored prospectively. The clinical characteristics, pathogen composition and drug sensitivity test results were analyzed by unified CRBSI diagnostic criteria. Results from January 2013 to December 2014, a total of 4175 patients were monitored, with a total of 38984 days of central vein catheterization, 125 cases of CRBSI occurred, and the infection rate of CRBSI was 3.21 per thousand. A total of 131 strains of pathogenic bacteria were isolated, including 74 strains of Gram-negative bacteria (56.49%), 37 strains of Gram-positive bacteria (28.24%) and 20 strains of fungi (15.27%). Among the main pathogens, methicillin-resistant coagulase-negative Staphylococcus, carbapenem-resistant Klebsiella pneumoniae, ESBLs-producing Escherichia coli, meropenem resistant Pseudomonas aeruginosa were 75.0%, 23.5%, 30.8% and 33. 3%, respectively. The sensitivity rates of coagulase negative staphylococci to vancomycin, linazodine, tegacycline and furantoin were 100.0%, Pseudomonas aeruginosa was low to aminoglycosides and quinolones were 10.0%, and the resistance rates of candida tropicalis to itraconazole and fluconazole were 50.0% and 25.0%, respectively. the resistance rates of Pseudomonas aeruginosa to aminoglycosides and quinolones were 10.0% and 25.0%, respectively. Conclusion Monitoring the occurrence and etiological changes of ICU and non-ICU CRBSI is helpful to further strengthen effective preventive and control measures and provide early empirical antibacterial therapy.
【作者單位】： 杭州市第一人民醫(yī)院醫(yī)院感染管理科;杭州市第一人民醫(yī)院醫(yī)院檢驗(yàn)科細(xì)菌室;杭州市第一人民醫(yī)院醫(yī)院血液科;杭州市第一人民醫(yī)院醫(yī)院老年內(nèi)科;杭州市第一人民醫(yī)院醫(yī)院胃腸外科;
【基金】：浙江省科技廳重大科技專項(xiàng)計(jì)劃基金資助項(xiàng)目(2014C03042-2) 杭州市科技發(fā)展計(jì)劃項(xiàng)目醫(yī)療衛(wèi)生及重點(diǎn)�？茖２】蒲泄リP(guān)專項(xiàng)基金資助項(xiàng)目(20120633B01)
【分類號】：R446.5

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