ICU机械通气患者多重耐药菌定植与感染状况调查分析

摘要

Objective To study the multi-drug resistance fix-planting and infection condition of patients treated with mechanical ventilation in ICU. Methods From March 2012 to March 2013, 128 patients were chosen as research subjects. It used MRSA and VRE type ESBILs and chromogenic medium to screen E-coli samples ( Es-chericia coli, EC), Klebsiella pneumoniae (KP), methicillin-resistant staphylococcus aureus (MRSA), vancomy-cin-resistant enterococci ( VRE) and other bacteria. Results 132 strains of bacteria were isolated, including 114 strains of EC, 8 strains of MRSA, 5 strains of KP, and 5 strains of VRE. The main colonization and infection were EC. Taking the stay in ICU ≤ 48 h as a cut point, there were 110 cases of multi-drug resistant patients and 112 strains were isolated, which the community-acquired patients accounted for 56. 36% (62/110). In addition, there was no significant difference in EC, MRSA, KP and VRE between hospital-acquired patients and community-acquired hospital (P>0. 05). Multi-drug resistance was detected in 18 case (ICU stay>48 hours) isolated and 20 strains were isolated. Conclusion The screening and monitoring on patients treated with mechanical ventilation in ICU should be strengthened, which can help their diagnosis and treatment.%目的：研究重症监护病房机械通气( mechanical ventilation,MV)患者多重耐药菌主动筛查及定植与感染状况调查分析。方法从2012年3月到2013年3月,选择128例住院患者作为研究对象。使用MRSA和ESBILs及VRE型显色培养基对样本中大肠埃希菌( Eschericia coli,EC)和肺炎克雷伯菌( Klebsiella pneumoiae,KP),以及耐甲氧西林金黄色葡萄球菌( Methicillin-resistant Staphylococcus aureus,MRSA)和耐万古霉素肠球菌( Vancomycin-resistant enterococci,VRE)等细菌进行筛查。结果128份送检标本中共分离多重耐药菌株共计132株。其中EC 114株,占比86．36%；MRSA 8株,占比6．06%；KP 5株,占比3．79%；VRE 5株,占比3．79%。132株多重耐药菌中,整体而言,定植与感染均以EC为主；进入ICU≤48h时,共有110例患者监测到多重耐药菌,经分离后得到112株,其中由社区带入者占比56．36%(62/110),由院内其他病室带入者占比43．64%(48/110),两者对比差异无统计学意义(P>0．05)。此外,社区和院内分别在EC、MRSA、KP及VRE等方面对比,差异均无统计学意义(均P<0．05)。进入ICU>48 h后,共有18例患者被监测出含有多重耐药菌,并分离耐药菌株20株。结论强化对ICU机械通气患者多重耐药菌的筛查与分析十分必要,此举有助于临床准确诊断和治疗,值得临床推荐应用。