重症监护病房患者腹腔感染病原菌谱分析
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臧彬

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R459.7

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辽宁省科学技术计划项目(201102293)


Pathogen spectrum of intraabdominal infection in patients in intensive care unit
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    摘要:

    目的分析重症监护病房(ICU)患者腹腔感染病原菌谱分布。方法回顾性分析2012年1月—2013年3月某院ICU收治的1 330例患者中腹腔感染及分离病原菌情况。结果283例患者出现腹腔感染,感染发病率为21.28%;133例(47.00%)患者检出病原菌186株, 其中革兰阴性杆菌128株(68.82%),革兰阳性球菌53株(28.49%),真菌5株(2.69%)。主要革兰阴性杆菌为大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌,主要革兰阳性球菌为屎肠球菌、金黄色葡萄球菌和粪肠球菌。入住ICU ≤2、3~7、8~14、>14 d分别检出病原菌131株(70.43%)、24株(12.90%)、19株(10.22%)、12株(6.45%);其中入住ICU≤48 h主要为大肠埃希菌(51株)、屎肠球菌(21株),入住ICU>48 h以鲍曼不动杆菌(18株)为主。病原菌主要检出于肠道、肝胆系统部位病变术后,分别占53.23%、24.19%。39例患者(29.32%)检出2种及以上病原菌,其中29例患者检出2种病原菌。结论腹腔感染病原菌以肠道及肝胆系统疾病术后检出较多,多种病原菌混合感染情况多见,且以革兰阴性杆菌为主。入住ICU 48 h内腹腔感染以大肠埃希菌及屎肠球菌为主,48 h后以条件致病菌为主。

    Abstract:

    ObjectiveTo analyze pathogen spectrum of intraabdominal infection in patients in an intensive care unit(ICU).MethodsIntraabdominal infections and pathogens of 1 330 patients who admitted to ICU from January 2012 to March 2013 were analyzed retrospectively.Results283 patients developed intraabdominal infection, incidence of infection was 21.28%;  133 (47.00%)patients were detected 186 isolates of pathogens, the proportion of gramnegative bacilli, grampositive cocci, and fungi were 68.82%(n=128),28.49%(n= 53), and 2.69%(n=5) respectively. The major gramnegative bacilli were Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumoniae, the major grampositive cocci were Enterococcus faecium,Staphylococcus aureus, and Enterococcus faecalis. The detection rates of pathogens after patients stayed in ICU for ≤2, 3-7, 8-14,and>14 days were 70.43%(n=131), 12.90%(n=24), 10.22%(n=19), and 6.45%(n=12)respectively; Escherichia coli(n=51) and Enterococcus faecium (n=21)were the main pathogens when patients stayed in  ICU for ≤48 hours, Acinetobacter baumannii was the main pathogen when patients stayed in ICU for >48 hours. Most  intraabdominal infection occurred after intestinal tract(53.23%) and hepatobiliary system operation(24.19%). 39 (29.32%) patients isolated at least two kinds of pathogens, 29 of whom isolated 2 kinds of pathogens.ConclusionMost pathogens of intraabdominal infection in ICU patients are detected following  intestinal tract and hepatobiliary  operation, and mixed pathogens are common, predominantly gramnegative bacilli. Escherichia coli and Enterococcus faecium are the main pathogens when patients stayed in ICU for ≤48 hours, opportunistic pathogens are the main pathogens when patients stay in ICU for >48 hours.

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汪海源,吴兴茂,臧彬.重症监护病房患者腹腔感染病原菌谱分析[J]. 中国感染控制杂志,2015,14(10):681-684. DOI:10.3969/j. issn.1671-9638.2015.10.008.
WANG Haiyuan, WU Xingmao, ZANG Bin. Pathogen spectrum of intraabdominal infection in patients in intensive care unit[J]. Chin J Infect Control, 2015,14(10):681-684. DOI:10.3969/j. issn.1671-9638.2015.10.008.

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  • 收稿日期:2015-01-25
  • 最后修改日期:2015-03-02
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  • 在线发布日期: 2015-10-30
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