ICU内重症创伤感染者病原菌及耐药菌的分布

目的 调查研究ICU内重症创伤感染者病原菌及耐药菌的分布.方法 对2015年1月至2016年6月来源于重庆市黔江中心医院ICU内重症创伤感染患者的标本进行细菌培养,并回顾性分析药敏试验结果.结果 革兰氏阴性杆菌占比为65.50%(131/200),高于革兰氏阳性杆菌的11.50%(23/200)以及真菌的23.00%(46/200),而真菌占比又高于革兰氏阳性杆菌,差异均有统计学意义(均P<0.05).其中革兰氏阴性杆菌主要包括鲍氏不动杆菌、肺炎克雷伯菌、大肠埃希菌及铜绿假单胞菌,而革兰氏阳性菌主要包括金黄色葡萄球菌、屎肠球菌与粪肠球菌.鲍氏不动杆菌的耐药率最高,均在60.00%以上,而铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌对哌拉西林/他唑巴坦、亚胺培南、阿米卡星具有较好的敏感性.屎肠球菌、粪肠球菌、金黄色葡萄球菌对万古霉素的耐药性分别为22.22%(2/9)、0(0/5)、0(0/4).结论 ICU内重症创伤感染者病原菌主要为革兰氏阴性杆菌,且耐药较为严重,临床医师应根据耐药性调整抗菌药物的使用,以减缓病原菌对抗菌药物产生耐药.

Distribution of pathogens and drug resistance of bacteria in severe trauma patients at ICU

Objective To study the distribution of pathogens and drug resistance of bacteria in severe trau-ma patients at ICU. Methods From January 2015 to June 2016, the specimens from patients with severe trauma in our hospital ICU was isolated for bacterial culture, and drug susceptibility test results were retrospectively analyzed. Results The proportion of Gram-negative bacilli was 65.50%(131/200), which was significantly higher than 11.50%(23/200) for Gram-positive bacillus, and 23.00% (46/200) for fungi, and the differences between the three types of pathogens were significant (all P<0.05). Gram-negative bacillus mainly included Boydii acinetobacter, Klebsiella pneu-moniae and E. coli and Pseudomonas aeruginosa, while Gram-positive bacteria mainly included Staphylococcus aureus, Enterococcus faecium, and Enterococcus faecium. Acinetobacter baumannii had the highest resistance rate, more than 60.00%, and Pseudomonas aeruginosa, Klebsiella pneumoniae and E. coli had better sensitivity to piperacillin-tazobac-tam, imipenem, amikacin. The resistance rates of Enterococcus faecium, and Enterococcus faecium, Staphylococcus aureus to vancomycin were 22.22%(2/9), 0 (0/5), 0 (0/4), respectively. Conclusion The infection pathogenic bacte-ria in ICU for severe trauma are mainly Gram-negative bacilli, and resistance is relatively serious, Clinicians should adjust the use of antimicrobial drugs according to drug resistance to slow the pathogen resistance to antimicrobial agents.