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目的调查珠江医院神经外科重症监护病房(ICU)病原菌的分布与耐药情况,分析ICU院内感染的发生原因,探讨防治对策。方法应用法国VITEKⅡ全自动细菌鉴定仪鉴定病原菌,用纸片扩散法检测药敏结果。结果神经外科ICU菌群主要以革兰阴性杆菌(71.6%)为主,鲍曼不动杆菌占16.7%,大肠埃希菌占15.7%,铜绿假单胞菌占13.7%,肺炎克雷伯菌占13.7%等。但葡萄球菌、粪肠球菌等阳性球菌(28.4%)也有增加的趋势。亚胺培南和头孢哌酮/舒巴坦仍保持最高抗菌活性,细菌的耐药率分别为15.3%和30.6%。结论我院神经外科ICU感染主要病原菌是革兰阴性杆菌,对常用抗菌药物耐药性较高,但革兰阳性球菌所占比例呈增高趋势。控制第二、三代头孢菌素以及制酸剂(质子泵抑制剂)的预防性用药,减少耐药菌株的产生,有针对性地使用抗生素是控制危重病人感染的有效措施。
Objective To investigate the distribution and drug resistance of pathogens in neurosurgical intensive care unit (ICU) in Zhujiang Hospital, analyze the causes of nosocomial infections in ICU and discuss the control strategies. Methods The French VITEK Ⅱ automatic bacterial identification instrument was used to identify the pathogen, and the disk diffusion method was used to detect the drug susceptibility results. Results The majority of neurosurgical ICU isolates were Gram-negative bacilli (71.6%), Acinetobacter baumannii accounted for 16.7%, Escherichia coli 15.7%, Pseudomonas aeruginosa 13.7%, Klebsiella pneumoniae Accounting for 13.7% and so on. However, Staphylococcus aureus, Enterococcus faecalis and other positive cocci (28.4%) also increased. Imipenem and cefoperazone / sulbactam still maintained the highest antibacterial activity, the resistance rates of bacteria were 15.3% and 30.6% respectively. Conclusions The main pathogen of ICU infection in neurosurgical department of our hospital is Gram-negative bacilli, which has higher resistance to commonly used antibiotics, but the proportion of gram-positive cocci is increasing. Control of the second and third generation cephalosporins and antacids (proton pump inhibitors) preventive medication to reduce the generation of drug-resistant strains, the targeted use of antibiotics is an effective measure to control critically ill patients infected.