重症患者侵袭性真菌感染流行现状

介绍了侵袭性真菌感染的定义及其相关概念,详细阐述了重症监护室内常见病原真菌的种类和流行特点,以期对未来的真菌诊疗控制起到一定参考意义。     

中国侵袭性真菌耐药监测网成员单位重症监护室侵袭性酵母的分布特征及其对唑类药物敏感性的变迁

目的回顾性分析2010-2014年中国侵袭性真菌耐药监测网(CHIF-NET)62所监测中心重症监护室(ICU)侵袭性酵母的现状,了解我国侵袭性酵母分布的特征及其对唑类药物的耐药情况。方法收集各所监测中心初步鉴定的菌株,送至北京协和医院检验科,采用基质辅助激光解吸电离飞行时间质谱技术结合分子测序技术对所有菌株进行复核鉴定,再进行唑类药物敏感性检测。结果2010-2014年,62所监测中心ICU共检出侵袭性酵母2863株,其中以念珠菌属最多,计2771株。标本类型包括血液标本(50.8%,1453/2863),无菌体液标本(49.2%,1410/2863);其中,50.7%(1404/2771)的念珠菌属分离自血液标本。5年间,白念珠菌对氟康唑和伏立康唑十分敏感,敏感率>99.0%;热带念珠菌对氟康唑和伏立康唑的耐药率显著升高,均从12.2%升至23.1%(P<0.01);光滑念珠菌对氟康唑的耐药率也显著升高,从14.7%升至27.7%(P<0.01)。非念珠菌属中,新型隐球菌复合体对伏立康唑全部敏感,从2013年开始出现对氟康唑耐药菌;其他酵母对两种唑类药物耐药率整体较高,分别为43.6%和32.7%。菌株复核鉴定的正确率为86.2%(2467/2863)。结论ICU中侵袭性酵母分离株中以念珠菌属为主,主要分离自血液,氟康唑和伏立康唑对其抗菌作用非常显著;而非白念珠菌的耐药率有不同程度的升高及交叉耐药的出现,临床需要加以重视。     

重症监护室患者深部真菌感染临床分析

目的 探讨重症病房患者深部真菌感染的临床特点,以利早期防治真菌感染的发生.方法 回顾性分析45例真菌感染患者的临床资料.结果 深部真菌感染的发病率为10.8%(45/415),老年患者发病率高,菌种分布以白色念珠菌最多,真菌感染的发生与长期应用广谱抗菌药物、侵入性操作、使用激素以及糖尿病密切相关.结论 应注意消除诱发因素,早期防治真菌感染的发生.     

2007-2009年医院重症监护室病原菌流行分布及耐药分析

目的 调查研究温州市中西医结合医院重症监护室(ICU)病原菌的感染分布情况与耐药变迁,为临床合理用药提供参考数据.方法 对2007年1月至2009年12月的ICU感染患者的临床资料进行统计分析.其中2007年2019例,2008年2801例,2009年2300例.结果 2007-2009年期间铜绿假单胞菌的感染检出率一...     

外科重症监护室645例脓毒症患者临床流行病学调查

目的了解脓毒症在外科重症监护室（SICU）的发生情况。方法收集2003年1月～2004年12月上海市中西医结合医院SICU入住病例645例，统计全身炎症反应综合征（SIRS）、脓毒症、严重脓毒症和脓毒性休克的发生率、病死率及其与年龄、性别的关系，以及在住院时间上的差异。结果术后第1日SIRS的发生率为63．7％。术后第2日为49．8‰，在SICU期间SIRS发生率为74．3％；未发生SIRS组无死亡病例，发生SIRS组病死率为6．26％。脓毒症发生率为27．0％，严重脓毒症为10．9％，脓毒性休克为7．0％；其病死率分别为14．94％、34．29％和51．11％。脓毒症和非脓毒症患者在年龄上存在差异（P〈0．01），老年人更易发生；在性别上存在差异（P〈0．01）．男性比女性更易发生。在住院时间上脓毒症和非脓毒症患者间差异有显著性（P〈0．01）。结论脓毒症在SICU较为常见，有高龄、男性易发生的特点，严重影响患者预后；须重视明确定义，提高治疗效应。     

重症监护室45例深部真菌感染菌种分类及药敏实验分析

近年来随着广谱抗菌药物的广泛应用、各种有创诊疗操作的深入开展,院内真菌感染发病率逐渐提高[1].因真菌感染病情凶险,病死率高,已引起临床医帅的高度重视.现对我院2006年6月至2007年6月收治的45例真菌感染患者的真菌培养结果进行回顾性分析.     

重症监护室护士工作压力调查

目的了解重症监护室（ICU）护士工作中主要的压力源及主要的工作压力,为护理管理者有效地帮助ICU护士减轻工作压力提供依据。方法采用问卷调查法对87名ICU护士、83名病房护士的工作压力进行调查分析。结果在护理专业及工作方面的问题、工作量及时间分配问题和患者护理方面的问题有明显差异;主要工作压力均比病房护士高;工作压力随工龄增加明显升高。结论建议管理者减少或消除护士压力源,并对护士进行业务培训和心理压力承受训练,减轻ICU护士各方面负担,提高工作效率。     

重症监护室护理人员职业紧张状况的调查

目的 调查分析重症监护室（ICU）护理人员的职业紧张状况,以便积极采取相应的改善措施.方法 选取唐山市254名ICU护理人员,填写一般情况和职业紧张量表,并分析其结果.结果 ICU护理人员职业紧张前10位为：组内冲突、任务不一致性、角色冲突、角色模糊、责任性、工作需求、工作挑战性、友谊机会少、速度不易控制、组间冲突.而职业紧张的调节因素为：心理控制源,同事支持,工作满意度,生活态度,家庭支持,非管理人员,负性事件,家庭收入情况一般,寻求社会支持,任务策略,逻辑性,行为特征.结论 ICU护理人员职业紧张情况较为严重,建议对其进行职业培训和心理辅导,从而提高服务水平和生活质量.     

重症监护室耐头孢吡肟铜绿假单胞菌的分子流行病学调查

目的:初步了解ICU中耐头孢吡肟铜绿假单胞菌(PA)的分子流行病学,为防治感染和临床用药提供参考.方法:回顾性收集我院2016年1月-2019年12月期间分离的161株PA菌,根据是否对头孢吡肟耐药分为FEP-R组和FEP-S组,统计PA菌株的临床特征及药敏结果,通过PFGE方法进行同源性检测,PCR进行耐药基因检测,...     

重症监护室用药安全管理的探讨

[目的]提高重症监护室药物存放和使用的安全性.[方法]加强病区药物的管理,尤其是对特殊药物的管理,加强护士培训,规范护士用药流程,规范与静脉药物中心的药物交接等.[结果]未发生用药差错及因药物应用不当引起的不良反应,药品保证安全有效.[结论]加强对护理人员的药学知识及管理能力培训、规范用药流程,能确保病人用药安全.     

The changing epidemiology of HIV-infected patients in the intensive care unit

With the introduction of highly active antiretroviral therapy (HAART), HIV has become a chronic disease. As HIV-infected patients are aging, they are at increased risk for comorbid diseases. These non-AIDS related diseases account for a growing proportion of intensive care unit (ICU) admissions in HIV-infected patients in recent studies. HIV-infected patients still present to the ICU with HIV-related conditions such as Pneumocystis jirovecii pneumonia (PCP), but these conditions are becoming less common. Respiratory failure remains the most common indication for ICU admission. Immune reconstitution inflammatory response syndrome and toxicities related to HAART may also result in ICU admission. While ICU survival has improved since the earliest era of the HIV epidemic, hospital mortality for HIV-infected patients admitted to the ICU remains around 30%. Risk factors for ICU mortality include poor functional status, weight loss, more than one year between HIV diagnosis and ICU admission, lower serum albumin, higher severity of illness, need for mechanical ventilation, and respiratory failure-particularly if due to PCP and accompanied by pneumothorax. The impact of HAART on ICU outcomes is unclear. HAART administration in the ICU can be challenging due to limited delivery routes, concern for viral resistance and medication toxicities. There are no data to determine the safety or efficacy of HAART initiation in the ICU. Future studies are needed to address the role of age, associated comorbidities and impact of HAART on outcomes of HIV-infected patients admitted to the ICU.     

Molecular epidemiology of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit

OBJECTIVES: To investigate the molecular epidemiology of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae in the neonatal intensive care unit of a university hospital in Italy. METHODS: Antibiotic susceptibility was evaluated by disc diffusion and Etest. ESBLs were identified by isoelectric focusing, PCR and DNA sequencing analysis. Genotyping was performed by PFGE analysis. Conjugation was performed by broth mating. RESULTS: Molecular typing of K. pneumoniae isolates identified three distinct PFGE patterns. Isolates of PFGE profile A were isolated during an epidemic in 1996, while isolates of PFGE profiles B and C were sequentially isolated from September 2002 to December 2004, when 233 colonizations and 19 infections by K. pneumoniae occurred. All K. pneumoniae strains of different PFGE types were identified as ESBL producers. DNA sequencing of amplified beta-lactamase genes identified a novel bla(TEM) ESBL (bla(TEM-136)) along with bla(SHV-1) in chromosomal and plasmid DNA from K. pneumoniae of PFGE type A, respectively, and bla(TEM-1) and bla(SHV-12) in plasmid DNA from K. pneumoniae of PFGE types B and C. Conjugation experiments demonstrated that resistance to third-generation cephalosporins, along with an approximately 80 kb plasmid containing bla(SHV-12) and bla(TEM-1), was transferred from K. pneumoniae epidemic strains of PFGE types B and C to a susceptible Escherichia coli host at a frequency of 4 x 10(-6) and 1 x 10(-6) cfu/recipient cell, respectively. CONCLUSIONS: The selection of ESBL-producing clones and the transfer of the bla(SHV-12) ESBL gene between different clones were responsible for the spread of K. pneumoniae in the neonatal intensive care unit.     

重症监护病房中呼吸机相关性肺炎的病原学研究

目的：监测呼吸内科重症监护病房(ICU)中呼吸机相关性肺炎(VHP)患者下呼吸道及肺部感染菌的分布，测定其药敏．为临床治疗VAP提供经验性选药依据。方法：采集患者的痰、下呼吸道分泌物、保护性毛刷刷检物(PSB)、肺泡灌洗液(BAL)和气囊上滞留物标本．分离菌应用API细菌鉴定系统鉴定，药敏检测应用纸片扩散法，统计软件应用WHONET5．1软件。结果：共分离出513株病原菌．其中革兰阴性杆菌416株，占总分离菌的81．1%．其中以铜绿假单胞菌和鲍曼不动杆菌居多．分别占31．4％和25．7％．革兰阳性球菌32株，以金黄色葡萄球菌居多．占3．5％。酵母样真菌65株，白念珠菌居多．占5．1％。铜绿假单胞菌对阿米卡星较敏感．耐药率为11．8％．其次是头孢吡肟、亚胺培南和头孢他啶．耐药率分别为23．6%、29．8％和36．6％。鲍曼不动杆菌对亚胺培南较敏感，耐药率为14．6%，对其他抗菌药物的耐药率多在80％以上。大肠埃希菌对亚胺培南和美罗培南较敏感．耐药率均为4％。金黄色葡萄球菌对万古霉素100％敏感．对苯唑西林的耐药率已达55．6％。结论：ICU中VAP患者的感染菌多为多重耐药菌，一旦怀疑感染．则应立即经验性应用足量的广谱抗菌药物．以降低病死率。     

Expanding intensive care medicine beyond the intensive care unit

Intensive care medicine probably requires the artificial boundaries of an intensive care unit to nurture and legitimize the specialty. The next major step in intensive care medicine is to explore ways of optimizing the outcome of seriously ill patients by recognizing and resuscitating them at an earlier stage. Some of these ways include better education of existing staff; earlier consultation; and automatic calling by intensive care staff to abnormalities identifying at-risk patients. Some of these interventions are currently being evaluated and results should soon indicate their relative effectiveness.     

Expanding intensive care medicine beyond the intensive care unit

Intensive care medicine probably requires the artificial boundaries of an intensive care unit to nurture and legitimize the specialty. The next major step in intensive care medicine is to explore ways of optimizing the outcome of seriously ill patients by recognizing and resuscitating them at an earlier stage. Some of these ways include better education of existing staff; earlier consultation; and automatic calling by intensive care staff to abnormalities identifying at-risk patients. Some of these interventions are currently being evaluated and results should soon indicate their relative effectiveness.