重症医学科患者血流感染细菌谱分析

发布时间：2018-05-03 07:58

本文选题：重症医学科 + 血流感染　；参考：《中国医科大学学报》2016年04期

【摘要】：目的分析重症医学科(ICU)患者血流感染(BSI)细菌谱及其时间分布特点,以便为临床抗生素的使用提供借鉴。方法根据是否置入中心静脉导管(CVC)将1 330例ICU患者分为CVC组及无CVC组,回顾性分析患者发生血流感染的比例、血流感染的细菌谱、构成比以及患者入住ICU不同时间段(第1周、第2周及2周以后)发生血流感染的细菌分布情况。结果 CVC组971例,血流感染96例(9.89%);无CVC组359例,血流感染12例(3.34%);总体血流感染率为8.12%。共分离出病原菌株157株,CVC组141株,无CVC组16株。感染细菌构成比革兰阴性杆菌、革兰阳性球菌和真菌分别为56.7%、32.5%和10.8%;前5位细菌分别为葡萄球菌(16.6%)、鲍曼不动杆菌(15.9%)、肠球菌(14.6%)、铜绿假单胞菌(10.2%)和克雷伯菌(10.2%)。从时间分布上看,无CVC组第1周、第2周血流感染革兰阴性杆菌分别为3例、4例,第2周以后革兰阳性球菌5例,而真菌则未检出;CVC组在第1周、第2周及2周后革兰阴性杆菌、革兰阳性球菌及真菌分别为第1周31例、24例、3例,第2周23例、12例、11例,2周后26例、8例、3例。革兰阴性杆菌、革兰阳性球菌及真菌所占比例第1周分别为53.4%、41.4%和5.2%,第2周分别为50%、26.1%和23.9%,2周以后分别为70.3%、21.6%和8.1%,第2周出现真菌血症的概率最高。结论入住ICU第1周、第2周患者血流感染以革兰阴性杆菌为主;2周后CVC组感染仍以革兰性阴性杆菌为主;无CVC组以革兰阳性球菌为主。真菌在CVC组中第2周出现可能性最高,无CVC组出现可能性极低;与CVC组比较,无CVC组血流感染率低,真菌血症发生率低。
[Abstract]:Objective to analyze the bacterial spectrum and time distribution of blood stream infection (BSI) in patients with ICU in order to provide reference for clinical use of antibiotics. Methods 1 330 patients with ICU were divided into CVC group and no CVC group according to whether or not the central venous catheter was inserted. The proportion of blood flow infection, the bacterial spectrum of blood flow infection, the composition ratio and the different time period of ICU (1 week) were analyzed retrospectively. After 2 weeks and 2 weeks) the distribution of blood stream infection bacteria. Results there were 971 cases in CVC group, 96 cases in blood flow infection group and 9. 89% in no CVC group, and 12 cases in CVC group. The total blood flow infection rate was 8. 12%. A total of 157 strains of pathogenic bacteria were isolated in CVC group and 16 strains in no CVC group. The composition of infected bacteria was higher than that of Gram-negative bacilli, Gram-positive cocci and fungi were 56.72.5% and 10.8%, respectively, and the first five bacteria were Staphylococcus (16.66%), Acinetobacter baumannii (15.9%), Enterococcus (14.610), Pseudomonas aeruginosa (10.2) and Klebsiella (10.2%). From the point of view of time distribution, there were 3 cases of Gram-negative bacilli in the CVC group at the 1st week and 4 cases at the second week, and 5 cases of Gram-positive cocci after the second week, while no positive bacteria were detected in the fungus group at the first week. In the second week and two weeks later, the Gram-negative bacilli, Gram-positive cocci and fungi were 31 cases, 24 cases, 3 cases, and 2 weeks, 23 cases, 12 cases, 11 cases, 2 weeks, and 26 cases, 8 cases, 3 cases, respectively. The percentage of gram-negative bacilli, gram-positive cocci and fungi in the first week was 41.4% and 5.2%, and in the second week was 50% 26.1% and 23.9%, respectively, which was 70.3% and 8.1% after 2 weeks. The probability of mycemia was the highest in the second week. Conclusion Gram-negative bacilli were the main blood stream infection in ICU for 2 weeks and Gram-negative bacilli were the main infection in CVC group and Gram-positive cocci in no CVC group. In the second week of CVC group, the probability of fungal appearance was the highest, and that of no CVC group was very low. Compared with CVC group, the blood flow infection rate and the incidence of mycemia were lower in no CVC group than in CVC group.
【作者单位】：中国医科大学附属盛京医院重症医学科;
【分类号】：R446.5

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