重症监护病房医院内感染临床特点及病原菌耐药性分析

目的 探讨重症监护病房(ICU)医院内感染的临床特点及病原菌种类、分布及其耐药情况,为临床合理使用抗菌药物、预防和控制医院感染提供参考和依据.方法 采用前瞻性监测与回顾性调查相结合的方法,对2008年4月至2010年3月我院ICU收治的392例住院患者临床资料进行统计分析.结果 发生医院感染78例,医院感染发生率为19.89%(78/392),感染112例次(28.57%);感染部位以下呼吸道为主,占54.46%(61/112),其次是泌尿道感染,占15.19%(17/112),血液感染占11.61%(13/112);分离出病原菌152株,以G-杆菌为主,占69.7%(106/152),其次是G+球菌,占17.8%(27/152),真菌占12.5%(19/152);主要病原菌鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌等对多种抗菌药物表现为高度耐药、多重耐药甚至泛耐药.结论 重症监护病房医院内感染发生率高,以下呼吸道感染为主,主要病原菌对抗菌药物耐药情况严重.规范、合理使用抗菌药物,控制多重耐药菌在ICU内的传播和流行,可减少ICU医院内感染的发生.

Clinical characteristics of hospital infection and pathogens drug resistance in intensive care unit

Objective To investigate the clinical characteristics of hospital infection and the pathogen type,distribution and drug resistance,in the intensive care unit of our hospital,to direct proper antibiotics use and supply the scientific basis for hospital infection control. Methods The clinical data of 392 inpatients in our intensive care unit from April 2008 to March 2010 were monitored prospectively and analyzed retrospectively. Results Of the 392 impatients,78 cases had hospital infection (19.89% 78/392),112 time-case infection (28.57% 112/392). The most common infection was the main respiratory tract infections accounted for 54.46% (61/112) ,followed by urinary tract infections accounted for 15. 19% ( 17/112 ), blood infection accounted for 11.61% (13/112). 152strains pathogens were identified in the study,in which G- bacilli accounted for 69.7%, G+ bacteria accounted for 17. 8% and fungi accounted for 12.5%. Main pathogens such as acinetobacter baumannii ,pseudomonas aeruginosa,klebsiella pneumoniae, staphylococcus aureus showed multiple drug resistance in different degrees. Conclusions Intensive care unit has a high nosocomial infection rate,lower respiratory tract infection is the most frequent type and the main pathogens have different degrees of multi-drug resistance. Standardized, rational use of antibiotics,prevention of the multi-drug resistant bacteria spread may help to reduce the occurrence of hospital infection in intensive care unit.