重症监护病房多重耐药感染情况及综合干预对策

温艺超?谢富华?陈伟燕

[摘要] 目的 观察分析重症监护病房（ICU）多重耐药感染的临床特点，以探讨防控ICU多重耐药感染的综合干预对策。 方法 回顾性分析2012年1月～2015年12月于我院治疗的288例ICU多重耐药感染患者的临床资料，分析多重耐药菌的检出率及分布情况。 结果 2012～2015年我院共发生感染882例，其中多重耐药菌感染288例，占比32.65%，多重耐药菌感染发生率在这4年呈逐年上升趋势。288例患者共分离307株多重耐药菌，其中革兰氏阴性菌214株，占比69.71%，革兰氏阳性菌88株，占比28.66%。其中以鲍曼不动杆菌最多，占比27.04%，其次铜绿假单胞菌，占比14.66%。多重耐药菌感染部位以下呼吸道为主，占比53.13%，其次是泌尿系统，占比12.15%。 结论 ICU多重耐药感染发生率呈逐年增加趋势，应当采取积极有效的综合干预对策控制和预防其传播。

[关键词] 重症监护病房；多重耐药感染；综合干预对策

[中图分类号] R446.5 [文献标识码] A [文章编号] 2095-0616（2017）14-158-04

Multiple drug resistance in intensive care unit and comprehensive intervention measures

WEN Yichao XIE Fuhua CHEN Weiyan

Department of Critical Medicine，The Second Affiliated Hospital of Guangzhou Medical University，Guangzhou 510260，China

[Abstract] Objective To observe and analyze the clinical characteristics of multiple drug-resistant infections in intensive care unit（ICU），and to explore the comprehensive intervention measures of ICU multi-drug infection. Methods The clinical data of 288 cases with ICU multidrug resistance in our hospital from January 2012 to December 2015 were retrospectively analyzed.The detection rate and distribution of multiple drug-resistant bacteria were analyzed. Results There were 882 cases of infection in our hospital from 2012 to 2015，including 288 cases of multidrug resistance occupied 32.65% of total，the incidence of multiple drug-resistant infections increased year by year in those four years.307 strains of multiple drug-resistant bacteria were isolated from 288 patients，among them including 214 strains of gram-negative bacteria with percentage of 69.71%，88 strains of gram-positive bacteria with percentage of 28.66%.Among them，baumanii was the most with percentage of 27.04%，followed by pseudomonas aeruginosa，with percentage of 14.66%.Most of multiple drug-resistant happened in lower respiratory tract with percentage of 53.13%，followed by the urinary system with percentage of 12.15%. Conclusion The incidence of ICU multiple drug infection is increasing year by year.Positive and effective comprehensive intervention measures should be taken to control and prevent its spreading.

[Key words] Intensive care unit； Multiple drug resistance； Comprehensive intervention measures

近年來，随着多种广谱抗生素的广泛应用，多重耐药感染发生率不断升高，已成为当前医院防控的重点和难点[1]。重症监护病房（ICU）作为危急重症病人的集中区，多数患者基础条件差，机体免疫能力低下，侵入性手术操作频繁且需接受大量抗菌药物治疗，因此在ICU患者中多重耐药感染尤为严重，已成为ICU患者死亡的高危因素[2]。因此，如何通过综合干预对策降低ICU患者多重耐药感染的发生并控制其传播和爆发已成为学者们研究的重点课题。本次研究对我院2012～2015年期间

收治的ICU多重耐药感染患者288例进行调查研究，并分析其感染特点和综合干预对策，以期为临床实践提供有效依据，现报道如下。……