重症监护病房患者腹腔感染病原菌谱分析

摘要

Objective To analyze pathogen spectrum of intra-abdominal infection in patients in an intensive care unit (ICU).Methods Intra-abdominal infections and pathogens of 1 330 patients who admitted to ICU from January 2012 to March 2013 were analyzed retrospectively.Results 283 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. Conclusion Most pathogens of intra-abdominal infection in ICU patients are detected following intestinal tract and hepato-biliary 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 patho-gens when patients stay in ICU for >48 hours.%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1330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。