摘要
目的了解重症监护室(ICU)与非ICU患者尿路感染病原菌分布情况及耐药性,为临床合理使用抗菌药物提供实验室依据。方法对2014年1月至2016年12月入住该院且符合《泌尿系感染诊断治疗指南2011版》尿路感染患者清洁中段尿或导尿管尿进行细菌分离培养与鉴定,并对ICU与非ICU尿路感染患者病原菌分布及耐药性进行对比分析。结果从ICU尿路感染患者标本中分离培养出病原菌281株,其中真菌92株(32.7%),G-菌127株(45.2%),G+菌62株(22.1%);非ICU患者标本分离培养出病原菌734株,其中真菌109株(14.9%),G-菌356株(48.5%),G+菌269株(36.6%)。ICU尿路患者真菌检出率高于非ICU患者(χ2=25.98,P<0.01);革兰阴性菌检查率低于非ICU患者(χ2=20.21,P<0.01)。ICU病房分离出的白色念珠菌,热带念珠菌及光滑念珠菌对氟康唑及伊曲康唑的耐药率均>10%;分离出的大肠杆菌、肺炎克雷伯菌等对亚胺培南,美洛培南,多粘菌素等耐药率明显高于非ICU病房;分离出的粪肠球菌、屎肠球菌耐药率普遍高于非ICU病房,其中万古霉素耐药率ICU病房更是非ICU病房的6倍。结论 ICU患者真菌检出率高,其感染的病原菌耐药严重,且明显高于非ICU患者,应加强管理与监测。
Objective To analyze the distribution and drug resistance of pathogens isolated from patients in intensive care units(ICUs)and non-ICUs,so as to provide evidence for clinical anti-infective treatment.Methods Bacterial strains from patients who were admitted to our hospital from January 2014 to December 2016 and met the guidelines for the diagnosis and treatment of urinary tract infection were isolated,cultured and identified,Pathogenic distribution and antimicrobial resistance between ICUs and non-ICUs were compared and analyzed.Results 268 strains of pathogenic bacteria were isolated from patients in ICUs,including 92(32.7%)strains of fungi,127(45.2%)strains of Gram-negative bacteria and 62(22.1%)strains of Gram-positive bacteria;695 strains of pathogenic bacteria were isolated from patients in non-ICUs,including 109(14.9%)strains of fungi,356(48.5%)strains of Gram-negative bacteria and 269(22.1%)strains of Gram-positive bacteria.The positive rate of fungi from ICU was higher than that of non-ICUs(χ2=25.98,P<0.01).The detection rate of Gram-negative bacteria from ICU was lower than that of non-ICUs(χ2=20.21,P<0.01).The drug resistance rate of candida albicans,tropical candida and smooth candida from ICU to Fluconazole and Itraconazole was more than 10%.The resistance rates of Escherichia coli,Klebsiella pneumoniae in ICU to imipenem,meropenem and polymyxin were significantly higher than that of non-ICUs.The drug resistance rate of Enterococcus faecium and Enterococcus faecium in ICU was generally higher than that of non-ICUs.Vancomycin resistance rate in ICU ward was 6 times higher than that of non-ICUs.Conclusion The detection rate of fungi in ICU was higher than that of non-ICUs.The drug resistance of infected pathogens from ICU was significantly higher than that from non-ICUs.Management and monitoring should be strengthened.
作者
李毓龙
李阳超
毛炜
LI Yulong;LI Yangchao;MAO Wei(Laboratory department of Jianyang People′s Hospital,Chengdu Sichuan 641400)
出处
《国际检验医学杂志》
CAS
2018年第A02期34-39,共6页
International Journal of Laboratory Medicine
关键词
尿路感染
重症监护室
病原菌
耐药性
抗菌药物
合理用药
urinary tract infection
intensive care unit
pathogenic bacteria
drug resistance
antimicrobial agents
the rational use of drugs
