中国医科大学学报

中国医科大学学报

中国医科大学学报 ›› 2016, Vol. 45 ›› Issue (4): 356–360.doi: 10.12007/j.issn.0258-4646.2016.04.017

• 论著 • 上一篇    下一篇

重症医学科患者血流感染细菌谱分析

汪海源,洪涛,吴兴茂,臧彬   

  1. 中国医科大学附属盛京医院重症医学科,沈阳 110004
  • 收稿日期:2015-07-15 出版日期:2016-04-28 发布日期:2016-04-05
  • 通讯作者: 臧彬 E-mail:zangb@sj?hospital.org
  • 作者简介:汪海源(1978 -),男,主治医师,硕士.

Analysis of Blood Stream Infections in Intensive Care Unit

WANG Hai-yuan,HONG Tao,WU Xing-mao,ZANG Bin   

  1. Department of Critical Care Medicine,Shengjing Hospital,China Medical University,Shenyang 110004,China
  • Received:2015-07-15 Online:2016-04-28 Published:2016-04-05

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。

关键词: 重症医学科, 血流感染, 细菌

Abstract: Objective To analyze blood stream infections(BSI)in ICU patients,to explore the bacterial spectrum characteristics and time distribution,so as to provide a reference for the clinical use of antibiotics. Methods A retrospective analysis was carried out. A total of 1 330 patients admitted in our hospital intensive care uni(t ICU)from January 2012 to March 2013(15 months)were selected for the study,the occurrence rate of blood stream infections,the bacteria spectrum of it and the bacteria spectrum distribution in different period of time(admitted in ICU for the first week,second week and later)were analyzed. The subjects were divided into 2 groups(CVC cases and non-CVC cases)depended on CVC indwelling or not. Results There were 971 cases with central venous catheter(CVC),the occurrence of bloodstream infection were 96 cases,the infection rate was 9.89% ,including 359 non - CVC cases and 12 blood stream infection cases. The infection rate was 3.34% ,and the total blood infection rate was 8.12%. A total of 157 strains of pathogen were isolated,among which 16 strains were isolated from non-CVC cases. Infection of gram-negative bacilli,gram-positive cocci and fungi were 56.7%,32.5% and 10.8%,respectively. Staphylococcus(16.6%),Bauman acinetobacter(15.9%),Enterococcus(14.6%),Pseudomonas aeruginosa(10.2%)and Klebsiella(10.2%)were the most common bacteria. For the distribution of time,in non-CVC cases gram-negative bacilli were more than other bacilli in the first and second week(3 vs 1,4 vs 1)in ICU,more gram-positive cocci( 5 vs 2)were isolated after two weeks,no fungi were detected;in CVC cases,gram negative bacilli were in a dominant position all the time(the number of gram negative bacilli,gram positive bacteria and fungi were 31 cases,24 cases and 3 cases in the first week respectively,23 cases,12 cases,11 cases in the second week,26 cases,8 cases and 3 cases after the second week),the proportion of each species in the first week were 53.4%,41.4% and 5.2%,respectively,50%,26.1% and 23.9% in the second week,70.3%,21.6% and 8.1% after the second week . The highest fungemia was found in the second week. Conclusion For the 1st 2 weeks in ICU,the most common bacilli was gram negative bacilli with BSI. After 2 weeks admitted in the ICU,it was mainly gram negative bacilli in CVC cases,and mainly gram positive cocci in non-CVC cases. In the 2nd week,fungemia had the highest probability in CVC cases,and it appeared low possibility in non-CVC cases. Non-CVC cases have a lower risk of blood stream infection.

Key words: intensive care unit, blood stream infection, bacteria

中图分类号: 

  • R446.5
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