摘要
目的:了解心脏外科术后重症监护病房(ICU)感染病原菌的分布特点及耐药性,为临床治疗合理使用抗菌药提供科学依据。方法:对从2014年1月至2014年12月,在ICU病房治疗3天以上的心脏术后患者712例,定期进行痰、血及导管尖端细菌学检查,对从中分离出的126株非重复病原菌分布及其耐药性进行调查分析。结果:126株病原菌中,革兰阴性菌101株,占80.2%,以鲍曼不动杆菌(23.8%)、肺炎克雷伯菌(18.3%)、铜绿假单孢菌(11.1%)为主;革兰阳性菌21株,占16.6%,以金黄色葡萄球菌(6.3%)、粪肠球菌(4.7%)、肺炎链球菌(2.4%)为主;真菌4株,占3.2%,以白色假丝酵母菌(1.6%)为主;几种主要病原菌对各类抗菌药物的耐药程度各不相同,大部分菌株均呈现多药耐药的现象:多耐药以杆菌为主:鲍曼不动杆菌多耐药菌株率高达83.3%;肺炎克雷伯菌多耐药菌株率为21.7%;铜绿假单孢菌为21.4%。导管尖端培养菌株与血培养菌株一致率为46.2%;血培养菌株与痰培养菌株一致率为36.4%。结论:术后病原菌感染以杆菌为主,耐药性高。应及时进行ICU病原微生物检测及耐药性监测,合理应用抗生素,增强多耐药菌株出现意识,做好防控,减少多药耐药菌的产生。
Objective： To investigate the characteristics of pathogenic distribution and drug resistance in post cardiac surgery ICU and to provide scientific references for rational use of antibiotics in clinical practice.Methous： By regular bacteriological examination of the sputum,blood and catheter tips of 712 patients who were treated for more than three days in the ICU after their cardiac surgeries from January to December 2014,from which126 non-repetitive positive strains were isolated,examined and analyzed for their distribution and drug resistance. Results： Among the 126 positive strains,101 strains of Gram negative bacteria were detected,accounting for 80. 2%, comprised mostly of Acinetobacter Baumannii（ 23. 8%）, klebsiella pneumonia（ 18. 3%） and Pseudomonas aeruginosa（ 11. 1%）. 21 strains of Gram positive bacteria accounted for16. 6%,comprised mostly of Staphylococcus aureus（ 6. 3%）,Enterococcus faecalis（ 4. 7%） and Streptococcus pneumoniae（ 2. 4%）. 4strains of fungi were detected,accounting for 3. 2%,among which Candida albicans（ 1. 6%） topped the list. The major species of the bacteria had various levels of drug resistance. But most of them exhibited multi-drug resistance and they were mainly bacilli： The resistance rate of acinetobacter is83. 3%,Klebsiella pneumonia is 21. 7% and Pseudomonas aeruginosa is 21. 4%. The consistent rate of strains cultured from catheter tips and blood samples is 46. 2%; the consistent rate of strains from blood and sputum samples is 36. 4%. Conclusion： Bacilli are the most common bacteria that infect patients in post cardiac surgery ICU and possess high drug resistance. So we should detect pathogenic microorganisms and monitor drug resistance promptly in ICU,apply antibiotics reasonably,and raise the awareness,prevent against and reduce the incidence of multi-drug resistant bacteria.
出处
《心肺血管病杂志》
2015年第11期844-848,共5页
Journal of Cardiovascular and Pulmonary Diseases
关键词
重症监护病房
病原菌
耐药性
心脏外科
Post cardiac surgery ICU
Pathogenic bacteria
Drug resistance
