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目的了解 ICU 医院感染的流行病学及细菌耐药性情况,为临床防治提供依据。方法对同济医院 ICU 病房2002年1月～2003年9月所有分离的细菌菌株、真菌菌株及细菌耐药性进行回顾性调查。结果医院内感染仍以革兰氏阴性(G~-)菌为主(60.3%),其次为真菌(25.4%),革兰氏阳性(G~+)菌(14.3%)。G~-菌以铜绿假单孢菌为主(占42.5%)。真菌以白色念珠菌为主(87.2%)。G~+菌以金黄色葡萄球菌(金葡菌)为主(68.2%),金葡菌中耐苯唑青霉素的金葡菌(MRSA)占87.4%,表皮葡萄球菌(表葡菌)中耐苯唑青霉素的表葡菌(MRSE)占62.6%。在细菌耐药方面,G~-菌对舒普深、头孢他啶及亚胺培南耐药率较低。MRSA 对万古霉素仍敏感,无一例耐药。结论 ICU 感染中仍以 G~-菌为主,但真菌及 G~+菌已逐渐成为重要致病菌,应受到重视。获得性感染菌谱的变迁及细菌耐药率升高,使临床经验性选择抗生素治疗医院感染更加困难,及时掌握病原菌及耐药性的最新动态,指导临床医生正确选用抗生素,意义重大。
Objective To understand the epidemiology and bacterial resistance of ICU nosocomial infection and provide the basis for clinical prevention and treatment. Methods All isolates of bacterial strains, fungal strains and bacterial resistance in ICU ward of Tongji Hospital from January 2002 to September 2003 were retrospectively investigated. Results Gram - negative (G -) bacteria were the most common in hospital (60.3%), followed by fungi (25.4%) and Gram - positive bacteria (14.3%). G ~ - bacteria Pseudomonas aeruginosa (42.5%). Candida albicans fungi (87.2%). Staphylococcus aureus (Staphylococcus aureus) was dominant in Staphylococcus aureus (68.2%), Staphylococcus aureus (87.4%) was resistant to Oxacillin, Staphylococcus epidermidis Oxacillin-resistant Staphylococcus aureus (MRSE) accounted for 62.6%. In bacterial resistance, G ~ - bacteria on Shu Pu deep, ceftazidime and imipenem lower resistance rate. MRSA vancomycin is still sensitive, no case of drug resistance. Conclusions G ~ - bacteria still predominate in ICU infection, but fungi and G ~ + bacteria have gradually become important pathogenic bacteria and should be taken seriously. The change of acquired infection spectrum and the rise of bacterial resistance rate make it more difficult for clinicians to choose antibiotics to treat nosocomial infection and grasp the latest developments of pathogens and drug resistance in time to guide clinicians in choosing proper antibiotics.