• 大連醫(yī)科大學(xué)附屬一院重癥醫(yī)學(xué)科( 遼寧大連 116011) 通訊作者: 萬獻(xiàn)堯, E-mail: wanxianyao@ gmail. com #研究生, 現(xiàn)在工作單位: 粵北人民醫(yī)院加強(qiáng)醫(yī)療科;

目的  了解ICU中血流感染病原菌的分布特點(diǎn)及其耐藥性, 以指導(dǎo)臨床合理用藥。方法  回顧性分析2004 年1 月至2009 年9 月ICU內(nèi)血流感染患者微生物學(xué)和藥物敏感試驗資料, 比較排位前五位細(xì)菌的耐藥特征。結(jié)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(jié)論  近5 年多來ICU內(nèi)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(yùn)山 ,萬獻(xiàn)堯. 重癥加強(qiáng)治療病房內(nèi)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(hù)雜志, 2010, 9(5): 493-497. doi: 復(fù)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(xiàn)堯. Sepsis 診治進(jìn)展. 醫(yī)師進(jìn)修雜志( 內(nèi)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(xué)雜志, 2005, 15: 1071-1073.
11. 黃偉, 教鳴, 王晶, 等. 重癥監(jiān)護(hù)病房中產(chǎn)超廣譜β-內(nèi)酰胺酶革蘭陰性細(xì)菌致院內(nèi)感染的臨床調(diào)查. 中國呼吸與危重監(jiān)護(hù)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 .
  1. 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. 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. 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. 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. 5. 萬獻(xiàn)堯. Sepsis 診治進(jìn)展. 醫(yī)師進(jìn)修雜志( 內(nèi)科版) , 2005, 28( 8A) : 51-54.
  6. 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. 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. 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. 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. 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(xué)雜志, 2005, 15: 1071-1073.
  11. 11. 黃偉, 教鳴, 王晶, 等. 重癥監(jiān)護(hù)病房中產(chǎn)超廣譜β-內(nèi)酰胺酶革蘭陰性細(xì)菌致院內(nèi)感染的臨床調(diào)查. 中國呼吸與危重監(jiān)護(hù)雜志, 2003, 2: 291 -293.
  12. 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. 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 .