神经外科重症监护病房患者中心静脉导管相关血流感染病原菌分析

发布时间：2018-04-17 09:23

本文选题：神经外科 + 重症监护病房　；参考：《中国感染与化疗杂志》2017年06期

【摘要】：目的调查分析神经外科重症监护病房(NSICU)患者中心静脉导管相关血流感染的病原菌及其耐药性,为临床预防治疗提供依据。方法回顾性分析2014年1月-2017年1月解放军火箭军总医院NSICU452例中心静脉置管患者的临床资料,调查中心静脉导管相关血流感染的发生率、病原菌分布和药物耐药性情况。结果 452例中心静脉置管患者中发生中心静脉导管相关血流感染21例,感染率4.6%。股静脉部位置管感染率(10.5%)高于颈内静脉(4.0%)和锁骨下静脉(2.6%),三者比较差异有统计学意义(χ2=9.755,P=0.008)。发生中心静脉导管相关血流感染的患者中共分离鉴定出病原菌26株,其中革兰阳性菌13株(50.0%),革兰阴性菌11株(42.3%),真菌2株(7.7%)。革兰阳性菌中以表皮葡萄球菌(5株)、金黄色葡萄球菌(3株)最常见;革兰阴性菌中以肺炎克雷伯菌(4株)、黏质沙雷菌(3株)最常见;真菌为白念珠菌和近平滑念珠菌各1株。引起中心静脉导管相关血流感染的主要病原菌前2位是表皮葡萄球菌(19.2%)、肺炎克雷伯菌(15.4%);13株革兰阳性菌对青霉素、红霉素、苯唑西林、克林霉素有较高的耐药率;11株革兰阴性菌对头孢唑林、哌拉西林有较高的耐药率;2株念珠菌对氟康唑、伏立康唑、伊曲康唑、两性霉素B等药物高度敏感。结论 NSICU中心静脉导管相关血流感染病原菌中以革兰阳性菌为主,表皮葡萄球菌最为常见,革兰阴性菌中以肺炎克雷伯菌较为常见,且耐药率均较高。临床应注意无菌操作,并依据药敏试验结果选择合理的抗菌药物,减缓耐药性的产生。
[Abstract]:Objective to investigate the pathogens and drug resistance of central venous catheter associated blood flow infection in patients with NSICU in neurosurgical intensive care unit (ICU), and to provide evidence for clinical prevention and treatment.Methods the clinical data of patients with central venous catheterization in NSICU452 from January 2014 to January 2017 were analyzed retrospectively. The incidence, distribution of pathogenic bacteria and drug resistance were investigated.Results among 452 patients with central venous catheterization, 21 patients had central venous catheter related blood flow infection, the infection rate was 4.6%.The infection rate of the femoral vein was 10.5% higher than that of the internal jugular vein (4.0%) and the subclavian vein was 2.6%. The difference was statistically significant (蠂 ~ 2 ~ (9.755) P < 0.008).A total of 26 strains of pathogenic bacteria were isolated from patients with central venous catheter associated blood flow infection, of which 13 were Gram-positive bacteria, 11 were Gram-negative bacteria, 11 were Gram-negative bacteria, and 2 were fungi.Among Gram-positive bacteria, 5 strains of Staphylococcus epidermidis and 3 strains of Staphylococcus aureus were the most common; among Gram-negative bacteria, 4 strains of Klebsiella pneumoniae and 3 strains of M. Shareh were the most common, and the fungi were Candida albicans and nearly candida albicans.The main pathogens causing central venous catheter-related blood flow infection were Staphylococcus epidermidis 19.22um, Klebsiella pneumoniae 15.4m and 13 Gram-positive bacteria against penicillin, erythromycin and oxacillin.Clindamycin resistance of 11 Gram-negative bacteria to cefazolin and piperacillin to two Candida strains were highly sensitive to fluconazole, volconazole, itraconazole, amphotericin B and so on.Conclusion Gram-positive bacteria are the main pathogens of NSICU central venous catheter related blood stream infection, Staphylococcus epidermidis is the most common, Klebsiella pneumoniae is more common in Gram-negative bacteria, and the drug resistance rate is higher.We should pay attention to the aseptic operation in clinic and select reasonable antimicrobial agents according to the results of drug sensitivity test to slow down the emergence of drug resistance.
【作者单位】：中国人民解放军火箭军总医院重症医学科;
【分类号】：R446.5;R651

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