本文選題：重癥監(jiān)護(hù)室　切入點(diǎn)：醫(yī)院感染　出處：《中國(guó)呼吸與危重監(jiān)護(hù)雜志》2016年05期 　論文類型：期刊論文

【摘要】：目的了解重癥監(jiān)護(hù)室患者致病菌感染和耐藥情況,為預(yù)防重癥感染和經(jīng)驗(yàn)用藥提供參考依據(jù)。方法回顧性分析2013年1月至2014年12月首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院重癥監(jiān)護(hù)室的住院患者,細(xì)菌及真菌培養(yǎng)陽(yáng)性病例,分析其菌群分布及致病菌耐藥性。結(jié)果 2年間重癥監(jiān)護(hù)室患者共收集臨床非重復(fù)分離株2 088株,其中革蘭陰性菌1403株(67.2%),革蘭陽(yáng)性菌496株(23.8%),真菌189株(9.0%)。痰液等呼吸道標(biāo)本1324株(63.42%);血液標(biāo)本487株(23.33%);其他標(biāo)本277株(13.27%)。分離出鮑曼不動(dòng)桿菌(17.2%)、肺炎克雷伯菌(14.8%)、銅綠假單胞菌(9.9%)、白念珠菌(6.3%)、大腸埃希菌(5.6%)、陰溝腸桿菌(5.4%)、表皮葡萄球菌(5.0%)及金黃色葡萄球菌(4.7%)。碳青霉烯類耐藥腸桿菌科細(xì)菌(CRE)15株,占2.3%,其中肺炎克雷伯菌5株,陰溝腸桿菌4株。大腸桿菌中多耐藥菌株占86.4%,其中MDR占85.5%,XDR占0.9%;鮑曼不動(dòng)桿菌中多耐藥菌株占75.2%,其中XDR占72.1%,MDR占3.1%;銅綠假單胞菌中多耐藥菌株占10.6%。MRSA及MRCNS檢出率分別為49.0%和95.5%,耐萬(wàn)古霉素腸球菌(VRE)4株,均為糞腸球菌。真菌中白念珠菌131株(69.3%),光滑球念珠菌23株(12.2%)。白念珠菌對(duì)兩性霉素及5氟胞嘧啶均敏感,對(duì)其他抗菌素耐藥率小于1%;光滑球念珠菌耐藥率較白念珠菌及近平滑念珠菌高,但仍全部小于15%。結(jié)論重癥監(jiān)護(hù)室患者致病菌以革蘭陰性菌為主,排名前8位的致病菌分別是鮑曼不動(dòng)桿菌、肺炎克雷伯菌、銅綠假單胞菌、白念珠菌、大腸埃希菌、陰溝腸桿菌、表皮葡萄球菌及金黃色葡萄球菌。痰液及血液標(biāo)本多見。CRE占2.3%。大腸桿菌中多耐藥菌株最多,但主要以MDR為主;其次為鮑曼不動(dòng)桿菌,以XDR為主;銅綠假單胞菌中耐藥菌株最少。真菌中白念珠菌最多,耐藥率仍較低。
[Abstract]:Objective to investigate the pathogenic bacteria infection and drug resistance in intensive care unit (ICU) patients. Methods from January 2013 to December 2014, we retrospectively analyzed the positive cases of bacteria and fungi culture in intensive care unit of Beijing Anzhen Hospital affiliated to Capital Medical University. Results in the past two years, 2088 clinical non-repeated isolates were collected from patients in intensive care unit. 1403 strains of Gram-negative bacteria, 496 strains of Gram-positive bacteria, 1403 strains of Gram-positive bacteria, 189 strains of fungi, 1324 strains of sputum, 1324 strains of respiratory tract specimens, including sputum and other respiratory tract specimens, 1324 strains, 63.42%, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum. 9. 9%, C. albicans 6. 3%, Escherichia coli 5. 6%, Enterobacter cloacae 5. 4%, Staphylococcus epidermidis 5. 0) and Staphylococcus aureus 4. 70.There are 15 strains of carbapenem resistant Enterobacteriaceae. Accounting for 2.3% of which 5 strains of Klebsiella pneumoniae, Four strains of Enterobacter cloacae were isolated from Escherichia coli, of which 85.5% were MDR, 75.2% were multidrug resistant, 72.1% were XDR and 3.1% were multidrug resistant in Pseudomonas aeruginosa, respectively, the positive rates of 10.6%.MRSA and MRCNS in Pseudomonas aeruginosa were 85.5%, 75.2%, 72.1% and 3.1% respectively in Acinetobacter baumannii and Pseudomonas aeruginosa. 49.0% and 95.5% of them were resistant to vancomycin, 4 strains of Enterococcus vancomycin, All of them were Enterococcus faecalis. Among them, 131 strains of Candida albicans and 23 strains of Candida smooth were found to be sensitive to amphotericin and 5-fluorocytosine. The drug resistance rate of Candida smooth was higher than that of Candida albicans and Candida albicans, but all of them were less than 15. Conclusion Gram-negative bacteria are the main pathogenic bacteria in intensive care unit. The top 8 pathogens were Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Candida albicans, Escherichia coli, Enterobacter cloacae. Staphylococcus epidermidis and Staphylococcus aureus. The sputum and blood samples were mainly found in sputum and blood. The multidrug resistant strains in Escherichia coli were mostly MDR, followed by Acinetobacter baumannii and XDR. Pseudomonas aeruginosa was the least resistant strain and Candida albicans was the most and the resistance rate was still low.
【作者單位】： 首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院;
【分類號(hào)】：R459.7

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