重症监护病房患者二重感染及耐药分析

目的了解重症监护病房(ICU)患者并发二重感染的细菌种类及耐药情况。方法采取常规鉴定方法对ICU送检感染患者的血、尿、痰、分泌物等219份标本进行培养鉴定,按照美国临床实验室标准化委员会(NCCLS)推荐的表形确诊试验,检测超广谱β-内酰胺酶(ESBLs),用K-B琼脂扩散法检测分离菌对17种抗菌药物的耐药性,数据统计时将中敏归于耐药。结果219例ICU细菌感染患者二重感染的132例(60.3%),100例一般病房细菌二重感染只有11例(11.0%)(P<0.01);132例ICU感染患者中,两种细菌混合感染者109例,占二重感染82.6%,其中感染两种产ESBLs细菌16例,占12.1%;3种细菌混合感染者23例,占17.4%;ICU二重感染常见致病菌依次为铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌、金黄色葡萄球菌、阴沟肠杆菌、嗜麦芽寡养单胞菌、表皮葡萄球菌等;上述细菌均存在多重耐药现象;其中大肠埃希菌产ESBLs 86.4%,肺炎克雷伯菌90.6%。结论ICU患者易出现二重感染、多重耐药,其感染的治疗应慎重选用抗菌药物。

Superinfection and Multidrug Resistance of Patients in ICU: An Analysis

OBJECTIVE To analyze the superinfection and multidrug resistance of patients in ICU.METHODS(Isolation),cultivation,and identification of ESBLs and drug-sensitivity tests to 17 antibiotics in 219 clinical(specimens) from ICU were conducted.Susceptibility testing was performed by disk diffusion(KB) method,(according) the NCCLs standard to manipulate and judge the results.interim sensitivity was ascribed to resistance.RESULTS Totally 219 cases of patients with bacterial infection in ICU,in which there were 132 cases of patients with superinfection(60.3%),in the same time,100 cases of patients with bacterial infection in general wards,in which there were only 11 cases of patients with superinfection(11%),the superinfection in ICU and general wards had significant deference(P(<0.01)).From 132 cases of patients with superinfection in ICU,109 cases had dual bacteria infection,among them,16 cases had dual ESBLs bacterial infection.23 cases had triple bacterial(infection.) The most common pathogens in ICU were Pseudomonas aeruginosa,Escherichia coli,Klebsiella pneumoniae,(Acinetobacter) baumannili,Staphylococcus aureus,Enterobacter cloacae,Stenotrophomonas maltophilia,(Staphylococcus) epidermidis and others.There were multidrug resistance of all the bacteria.Among them,86.4% of E.coli and 90.6% K.pneumoniae strains could produce ESBLs.CONCLUSIONS Patients in ICU are(predisposed) to superinfection and multidrug resistance,so,the antibacterials should be selected cautionly in(treatment) of the patients with bacterial infection.