【摘要】 目的分析ICU中血流感染病原菌的分布特点、耐药性及影响预后的危险因素。方法回顾性分析ICU血流感染患者的一般情况、60d病死率、病原菌药敏结果、抗生素使用情况,对可能影响患者预后的危险因素进行分析。结果 422例ICU患者中发生血流感染28例,发生率为6.6%,60d病死率为32.1%。共检出83株病原菌:革兰氏阴性菌61株(73.5%),革兰氏阳性菌15株(18.1%),真菌7株(8.4%)。引起血流感染的主要病原菌依次为鲍曼不动杆菌(29株,34.9%)、铜绿假单胞菌(21株,25.3%)和凝固酶阴性葡萄球菌(10株,12.0%),耐药率均较高。死亡组(9例)急性生理与慢性健康评分Ⅱ、发生感染性休克、进行血液净化和对碳青霉烯类耐药的比例均高于生存组(19例)(P<0.05或P<0.01),适当抗生素治疗的比例低于生存组(P<0.01)。结论多重耐药的革兰氏阴性菌是ICU血流感染的主要病原菌,合并休克、肾衰及不恰当抗生素治疗提示预后不良。更多还原

【Abstract】 Objective To investigate the distribution and antibiotic resistance of the pathogens causing bloodstream infection and the prognostic risk factors of patients in ICU.Methods A retrospective analysis was performed in ICU patients with bloodstream infection by reviewing the baseline clinical characteristics,60-day mortality,sensitivity of pathogens to drugs and utilization of antibiotics.The underlying risk factors for influencing the prognosis in the survivors(group A,19cases)and non-survivors(group B,9cases)were analyzed.Results The incidence rate of bloodstream infection was 6.6%(28/422)and the 60-day mortality rate was 32.1%(9/28).A total of 83strains was detected,which included 61 Gram-negative(G-)bacteria(73.5%),15 Gram-positive(G+)bacteria(18.1%),and 7fungi(8.4%).The main pathogens causing bloodstream infection were Acinetobacter baumannii(29strains,34.9%),Pseudomonas aeruginosa(21strains,25.3%)and coagulase negative Staphylococci(10strains,12.0%).Multidrug-resistance pathogens were common.Acute physiology and chronic health evaluation(APACHE)Ⅱscore,the proportion of septic shock,continuous renal replacement therapy,and carbapenem-resistant pathogens in group B were significantly higher than those in group A(P<0.01or P<0.05).The proportion of appropriate antibiotic therapy in group B was significantly lower than that in group A(P<0.01).Conclusion The predominant pathogen of bloodstream infection in ICU is multidrug-resistant G-bacteria.Septic shock,renal failure and inappropriate antibiotic therapy indicate a poor prognosis in the patients with bloodstream infection.更多还原