摘要
目的 了解重症医学科(ICU)住院患者的病原菌感染情况及临床分布特征.方法 回顾性分析2017-2023年某三甲医院ICU住院患者的病原菌感染情况,应用SPSS 23.0软件对数据进行统计分析.结果 共检出病原菌株数5166例,其中多重耐药菌(MDROs)株数1612例.检出病原菌以肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌、铜绿假单胞菌、屎肠球菌、金黄色葡萄球菌、白念珠菌和热带念珠菌等为主.主要来源于痰液、肺泡灌洗液、尿液等,共占66.37％.MDROs以多重耐药鲍曼不动杆菌(MDR-AB,518株)、耐碳氢酶烯肺炎克雷伯菌(CR-KPN,526株)、产超广谱β-内酰胺酶大肠埃希菌(ESBLs-ECO,95株)、耐甲氧西林的金黄色葡萄球菌(MRSA,60株)为主.鲍曼不动杆菌仅对米诺环素的耐药率为8.53％,对包括碳青霉烯类的其他抗菌药物耐药率均较高,甚至超过80％;肺炎克雷伯菌、大肠埃希菌对多数抗菌药物耐药率均高于50％;铜绿假单胞菌对替卡西林-克拉维酸的耐药率为56.17％,对其他抗菌药物耐药率普遍较低.结论 ICU常见致病菌耐药情况较为严重,其中耐碳青霉烯肺炎克雷伯菌、耐碳青霉烯鲍曼不动杆菌和耐碳青霉烯铜绿假单胞菌的检出率明显升高,应成为感染防控工作重点.
Abstract
Objective To investigate the infection status and clinical distribution characteristics of pathogens in patients hospitalized in the intensive care unit(ICU).Methods The bacterial infection of hospitalized ICU patients in a grade A tertiary hospital from 2017 to 2023 was retrospectively analyzed,and the data were statistically analyzed by SPSS 23.0 software.Results A total of 5166 pathogenic bacteria were detected,including 1612 multi-drug resistant organisms(MDROs).The most detected pathogens were Klebsiella pneumoniae,Acinetobacter baumannii,Escherichia coli,Pseudomonas aeruginosa,Enterococcus faecium,Staphylococcus aureus,Candida albicans and Candida tropicalis.The infection specimens were mainly from sputum,alveolar lavage fluid and urine,accounting for 66.37％.MDROs predominantly included multi-drug-resistant Acinetobacter baumannii(MDR-AB,518 strains),carbapenem-resistant Klebsiella pneumoniae(carbapenem-resistant KPN,526 strains),extended-spectrum P-lactamases-producing Escherichia coli(ESBLs-ECO,95 strains),and methicillin-resistant Staphylococcus aureus(MRSA,60 strains).The resistance rate of Acinetobacter baumannii to minocycline alone was 8.53％,and the drug resistance rate of other antibacterial drugs,including carbapenems,was high,even exceeding 80％.The resistance rates to most antibiotics of Klebsiella pneumoniae and Escherichia coli were higher than 50％.The drug resistance rate of Pseudomonas aeruginosa to ticacillin-clavulanate was 56.17％,and the drug resistance rate to other antibiotics was generally low.Conclusion The drug resistance of common pathogens in ICU patients had become relatively serious,among which the detection rates of carbapenem-resistant Klebsiella pneumoniae,Acinetobacter baumannii and Pseudomonas aeruginosa had increased significantly,which should be the focus of infection prevention and control.
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