综合ICU血流感染病原菌分布及耐药性分析

目的了解某院综合重症监护室(ICU)血流感染病原菌的分布及耐药情况，为临床血流感染的预防和经验用药提供依据。方法回顾性分析该院综合ICU 2011年1月-2013年12月血培养阳性的385例患者的临床资料，对其病原菌检出及耐药情况进行统计分析。结果385例血培养阳性患者检出的病原菌以革兰阴性杆菌为主，占62.34%；革兰阳性球菌占27.01%；真菌占10.65%。居前5位的病原菌依次是大肠埃希菌(18.18%)、铜绿假单胞菌(16.10%)、金黄色葡萄球菌(15.59%)、不动杆菌属(13.25%)、肺炎克雷伯菌(9.09%)。耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的检出率分别为72.55%、68.34%。对于革兰阴性杆菌，亚胺培南、阿米卡星最为敏感（耐药率0～35.65%）。结论该院综合ICU送检血培养标本分离的病原菌以革兰阴性杆菌为主，耐药率高；临床应加强对疑为败血症患者的血培养标本送检，合理使用抗菌药物，有效控制感染。

Distribution and drug resistance of pathogens causing bloodstream infection in a general intensive care unit

Objective To explore the distribution and drug resistance of pathogens causing bloodstream infection in patients in a general intensive care unit（GICU）,and provide reference for the prevention of bloodstream infection and rational use of antimicrobial agents.Methods From January 2011 to December 2013,clinical data of patients who were diagnosed with bloodstream infection were reviewed retrospectively,detected pathogens and drug resistance were analyzed statistically.Results The major pathogens isolated from385 patients with positive blood culture were gram-negative bacilli,which accounting for 62.34%;isolation rate of gram-positive cocci and fungi was27.01%and 10.65%respectively.The top five pathogens were Escherichia coli（18.18%）,Pseudomonas aeruginosa（16.10%）,Staphylococcus aureus（15.59%）,Acinetobacter baumannii（13.25%）,and Klebsiella pneumoniae（9.09%）.The detection rate of methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase negative Staphylococcus was 72.55%and68.34%respectively.Gram-negative bacilli was most sensitive to imipenem and amikacin（resistant rate was 0-35.65%）.Conclusion Gram-negative bacilli are the main pathogens in blood culture from GICU in this hospital,and drug-resistant rates are high.It＇s important to strengthen blood culture of patients with suspected septicemia,use antimicrobial agents rationally and control infection effectively.