外科重症监护室5年医院感染资料回顾性分析 FREE

目的了解外科重症监护室（SICU）医院感染的病原菌分布及其耐药性。方法回顾性分析某院SICU 2004年10月 - 2009年9月间医院感染情况。结果5年平均医院感染率为9.79%（119/1 216），常见感染部位为下呼吸道（40.25%）、腹腔（28.39%）和血流（9.32%）。检出的病原菌中，革兰阴性菌占67.03%（185/276），以铜绿假单胞菌为主；革兰阳性球菌占22.83%（63/276），以凝固酶阴性葡萄球菌为主；真菌占10.14%（28/276）。肺炎克雷伯菌和大肠埃希菌产超广谱 β 内酰胺酶株检出率分别为38.46%和34.78%；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在相应细菌中的构成比分别为60.00%和58.82%。肠杆菌科细菌对碳青霉烯类、阿米卡星和左氧氟沙星敏感率较高，达86%以上；非发酵菌严重耐药，对碳青霉烯类耐药率达45%以上；替考拉宁和万古霉素对革兰阳性球菌具有高抗菌活性，敏感率达100%。结论SICU医院感染及感染病原菌的耐药问题严重，合理应用抗菌药物并及时掌握病原菌的耐药性变化是有效控制医院感染的关键。

Nosocomial infection in patients in a surgical intensive care unit: a 5 year analysis FREE

Objective To investigate the distribution and the drug resistance of pathogens in nosocomial infection （NI） in a surgical intensive care unit （SICU）. Methods NI prevalence was surveyed retrospectively in SICU of a hospital from October 2004 to September 2009. Results The average NI rate was 9. 790/oo （119/1 216）, the major sites of NI were lower respiratory tract （40. 25%）, abdominal cavity （28. 39%） and bloodstream （9. 32%）. Among isolated pathogens, 67.03% （185/276） were gram-negative bacteria, 22. 83% （63/276） were gram-positive cocci, and 10. 14% （28/276） were fungi. Pseudomonas aeruginosa and coagulase-negative Staphylococci （CNS） were the most frequent gram-negative and -positive organism, respectively. 38. 46% of Klebsiella pneumonia and 34. 78% Escherichia coli were tested positive for extended-spectrum 13-1actamase; 60. 00% of Staphylococcus aureus and 58. 82% of CNS were methicillin-resistant. Enterobacteriaceae were susceptible to carbapenems, amikacin and levo- floxacin, sensitive rate was up to more than 86% ; non-fermentative bacteria were seriously resistant to most antimicrobial agents, the resistant rate to carbapenems was more than 45 %; all gram-positive cocci were sensitive to both teicoplanin and vancomycin, the sensitive rate was 100%. Conclusion NI and drug resistance of pathogens in SICU are serious, rational use of antimicrobial agents as well as constant surveillance on microbial trends are essential to control NI effectively.