目的 了解ICU中血流感染病原菌的分布特點及其耐藥性, 以指導臨床合理用藥。方法 回顧性分析2004 年1 月至2009 年9 月ICU內血流感染患者微生物學和藥物敏感試驗資料, 比較排位前五位細菌的耐藥特征。結果 89 例血流感染患者共檢出112 株病原菌, 其中革蘭陽性( G+ ) 菌55 株, 占49. 1% ; 革蘭陰性( G- ) 菌55 株, 占49. 1% ; 真菌2 株, 占1. 8% 。引起血流感染的主要病原菌依次為洋蔥伯克霍爾德菌( 33 株, 29. 5% ) 、表皮葡萄球菌( 31 株, 27. 7% ) 、肺炎克雷伯菌和金黃色葡萄球菌( 各7 株, 6. 3% ) 、人葡萄球菌和鮑曼不動桿菌( 各6 株, 5. 4% ) 、銅綠假單胞菌和溶血葡萄球菌( 各5 株, 4. 5% ) , 提示G- 菌中以洋蔥伯克霍爾德桿菌為主, G+ 菌中以表皮葡萄球菌為主。G- 桿菌對碳青霉烯酶類最為敏感; G+ 球菌對萬古霉素的耐藥率為0. 0% 。結論 近5 年多來ICU內血流感染患者病原菌分布G+ 菌與G- 菌基本持平。在分離到的G+ 菌中以表皮葡萄球菌為
主, 在G- 菌中以洋蔥伯克霍爾德桿菌為主。碳青霉烯類與糖肽類抗生素是各自治療的首選。
引用本文： 羅運山 ,萬獻堯. 重癥加強治療病房內血流感染病原菌分布及其耐藥性分析. 中國呼吸與危重監(jiān)護雜志, 2010, 9(5): 493-497. doi: 復制
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- 1. Warren DK, Zack JE, Elward AM, et al. Nosocomial primary bloodstream infections in intensive care unit patients in a nonteaching community medical center: a 21-month prospective study. Clin Infect Dis, 2001, 33: 1329-1335.
- 2. Wisplinghoff H, Bischoff T, Tallent SM, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24 179 cases from a prospective nationwide surveillance study. Clin Infect Dis,2004, 39: 309-317.
- 3. Mylotte JM, Tayara A, Goodnough S. Epidemiology of bloodstream infection in nursing home residents: evaluation in a large cohort from multiple homes. Clin Infect Dis, 2002, 35: 1484 -1490 .
- 4. Lepper PM, Grusa E, Reichl H, et al. Consumption of imipenem correlates with bete-lactam resistance in Pseudomonas aeruginosa.Antimicrob Agents Chemother, 2002, 46: 2920-2925 .
- 5. 萬獻堯. Sepsis 診治進展. 醫(yī)師進修雜志( 內科版) , 2005, 28( 8A) : 51-54.
- 6. Diekema DJ, Pfaller MA, Jones RN, et al. Age-related trends in pathogen frequency and antimicrobial susceptibility of bloodstream isolates in North America. SENTRY Antimicrobial Surveillance Program, 1997-2000. Int J Antimicrob Agents, 2002 , 20: 412-418.
- 7. Lakshmi KS, Jayashree M, Singhi S, et al. Study of nosocomial primary bloodstream infections in a pediatric intensive care unit. J Trop Pediatr, 2007, 53: 87-92.
- 8. Wisplinghoff H, Seifert H, Tallent SM, et al. Nosocomial bloodstream infections in pediatric patients in United States hospitals: epidemiology, clinical features and susceptibilities.Pediatr Infect Dis J, 2003, 22: 686-691 .
- 9. Moubareck C, Meziane-Cherif D, Courvalin P, et al. VanA-type Staphylococcus aureus strain VRSA-7 is partially dependent on vancomycin for growth. Antimicrob Agents Chemother, 2009, 53 :3657-3663.
- 10. 黃翠雯, 周曉光, 黃嘉言. 新生兒敗血癥病原菌及其藥物敏感試驗分析. 中華醫(yī)院感染學雜志, 2005, 15: 1071-1073.
- 11. 黃偉, 教鳴, 王晶, 等. 重癥監(jiān)護病房中產超廣譜β-內酰胺酶革蘭陰性細菌致院內感染的臨床調查. 中國呼吸與危重監(jiān)護雜志, 2003, 2: 291 -293.
- 12. Grik K, Dierich MP, Pfaller K, et al. In vitro activity of fosfomycin in combination with various antistaphylococcal substances. J Antimicrob Chemother, 2001, 48: 209-217 .
- 13. Iskandar SB, Guha B, Krishnaswamy G, et al. Acinetobacter baumannii pneumonia: a case report and review of the literature.Tenn Med, 2003, 96: 419-422 .