【摘要】 目的分析急诊重症监护治疗病房(EICU)与急诊病房患者院内感染病原体分布差异与药敏差异及抗生素应用体会。方法选取2014年11月至2017年11月间在本院急诊病房住院患者6109例,EICU住院患者4842例,院内感染诊断依据患者临床体征、症状、感染部位、影像学检测资料、病原学检测结果等来判别;收集院内感染患者胸水、痰液、胸腔包积液、尿液、脑脊液、血清、深静脉导管、皮肤表层与深部脓腔等,进行细菌培养及检测和药敏检测。结果 EICU患者感染率为3.63%,高于急诊病房的1.52%,差异有统计学意义(P<0.05);急诊病房感染患者分离121株菌株,其中81株革兰阴性菌,占比66.94%,25株革兰阳性菌,占比20.66%,15株真菌,占比12.40%;EICU感染患者分离213株菌株,其中139株革兰阴性菌65.26%,43株革兰阳性菌,占比20.19%,31株真菌,占比14.55%;急诊病房与EICU感染病原菌鲍曼不动杆菌对多粘菌素B、替加环素敏感率在80%以上;肺炎克雷伯菌对阿米卡星、美罗培南、亚胺培南敏感率在80%以上;铜绿假单胞菌对多粘菌素B、左氧氟沙星、环丙沙星、妥布霉素、阿米卡星头孢他啶及美罗培南敏感率在80%以上。结论 EICU患者出现院内感染率要比急诊病房高,感染患者病原菌分布主要以革兰阴性菌为主,革兰阳性菌对利耐唑烷、万古霉素、替加环素等敏感度高,不同革兰阴性菌对抗菌药敏感率差异较大。更多还原

【Abstract】 Objective To analyze the distribution differences and drug sensitivity differences of nosocomial infection pathogens and the application of antibiotics in emergency intensive care unit( EICU) andemergency ward patients. Methods 6109 cases of hospitalized patients from November 2014 to November 2017 in the emergency ward in our hospital were selected,4842 cases of hospitalized patients with EICU,nosocomial infection diagnosis were made in patients according to clinical signs and symptoms,the infection sites,imaging data,pathogen detection; The pleural effusion,pleural effusion,sputum,urine,cerebrospinal fluid. Serum,central venous catheters,skin and deep abscess were collected,and bacterial culture and drug sensitivity test were performed and detected. Results The patients with EICU infection rate was 3. 63%,higher than that in emergency ward( 1. 52%),the difference was statistically significant( P < 0. 05); 121 strains isolated from patients with infection in emergency ward,including 81 strains of gram negative bacteria,accounting for 66. 94%,25 strains of gram positive bacteria accounted for 20. 66%,15 strains of fungi,accounting for 12.40%; EICU infection 213 strains were isolated,including 139 strains of gram negative bacteria 65. 26%,43 strains of gram positive bacteria,accounting for 20. 19%,31 strains of fungi,accounting for 14. 55%; the emergency ward and EICU Bauman Acinetobacter infection pathogens of polymyxin B and tigecycline susceptibility rate of 80% in Klebsiella pneumoniae; Amikacin,meropenem,imipenem susceptibility rate of more than 80%; to polymyxin B,levofloxacin,ciprofloxacin and tobramycin,Amikacin,ceftazidime and meropenem sensitive rate in more than 80% of Pseudomonas aeruginosa. Conclusion The hospital infection rate in EICU ward was higher than that in emergency ward,the infection and distribution of pathogens in patients was mainly infected by Gram-negative bacteria,and the Gram-positive bacteria was sensitive to vancomycin,Lee resistant oxazolidine,tigecycline sensitive,and different Gram-negative bacteria has different sensitivity to difference antibiotic.更多还原