60例ICU患者获得性感染的原因分析与预防(1)
[摘要]目的探讨我院ICU获得性感染的流行病学、致病菌分布及耐药情况,为医院感染的防治提供依据。方法 调查2008年1-12 月收治我院ICU的60例患者的感染发病率,感染原因,致病菌。结果 感染发生率36.7 %(22/60),发生2例次以上感染者占28.3 %(17/60) 。与留置尿管相关的泌尿道感染发病率为9.2 % ,与使用呼吸机相关的肺部感染发病率为36.8 %,与气管切开相关的肺部感染发病率为51.7%。感染部位占前3位的是肺部感染51.7 %(31/60) 、胃肠道感染18.3 %(11/60) 和泌尿道感染11.7%(7/60) 。分离出76株致病菌,仍以革兰氏阴性菌为主,占53.9%(41/76) 。居前3位的是绿脓杆菌26.1 %(25/76),真菌13.2 %(10/76),不动杆菌7.9%(6/76) 。结论 ICU 获得性感染发生率高,致病菌仍以革兰氏阴性菌为主,革兰氏阳性球菌及真菌有上升趋势,细菌耐药性升高,应建立ICU获得性感染监测制度,合理使用抗菌药物,并采取积极的预防和控制措施。
[关键词] ICU; 医院感染; 预防
, 百拇医药
[中图分类号] R47 [文献标识码]A [文章编号] 1005-0515(2010)-7-206-02
SEASON ANALYSIS AND PREVENTION ON NOSOCOMIAL DISEASE OF 120 PATIENTS AT ICU
Zhang Xingqun
nursing departmentof luxian traditional Chinese medical hospital
[Abstract]ObjectiveTo explore the epidemic causes ,distribution of pathogen and drug resistance of nosocomial disease at ICU of our hospital and provide evidence of protection to nosocomial disease.Methods 60 patients was collected from January to December in 2008 of ICU,and investage the rate of infection,the epidemic causes and the distribution of pathogen.Results The total incidence of nosocomial disease was 36.7 %; 28.3 % patients of nosocomial disease got infected more than twice. The incidence of catheter related urinary tract infection was 9. 2 % , respirator related lung infection was 36. 8 % and tracheotomy related lung infection was 51.7 %. The top three causes of nosocomial disease were respiratory tract infection (51.7 %) , alimentary infection(18.3%) and urinary tract infection (11.7%) . The leading microrganism cultured was gram-negative bacteria , about 53.9 %. The top three types were Pseudemonas aeruginosa ( 26.1 %) , fungus ( 13.2 %) and acinetobacter (7.9 %) . Conclusion it's high incidence rate of nosocomial disease in ICU. The princeps pathogenic bacteria was gram-negative bacteria;gram-positive bacteria and fungus infection was increasing. The rate of drug resistance was very high. It is advisable to set up the proper surveillance system , rational use of antibiotics and active prevention measures.
, 百拇医药
[Keywords]ICU ;Nosocomial disease ; Prevention
重症监护室获得性感染(nosocomial disease,ND)是指患者进入ICU室72h后继发的感染[1]。因收治的患者病情危重、免疫功能低下及侵入性操作多等原因,医院获得性感染的发生率明显高于普通病房,感染是导致抢救最终失败的最重要原因之一[2]。因此开展ICU住院病人医院感染的监测,了解各类型ICU 获得性感染的发病率及其危险因素,达到有效预防和控制ICU内医院感染的发生,具有极为重要的意义。本文对我院ICU收治的60例患者进行了医院感染监测,并对感染危险因素及致病菌进行分析,提出预防和控制措施。
1 材料与方法
1.1 临床资料
收集我院2008年1月至12月ICU病房60例患者进行观察,男性36例,女性24例,年龄15-65岁,其中涉及疾病包括急性脑血管病13例,急性呼吸窘迫综合征14例,高血压脑出血8例,肺部疾病5例,有机磷农药中毒6例,呼吸心跳骤停复苏后7例,重症胰腺炎7例。住院时间10-65天。
, 百拇医药
1.2 方法
对有院内感染可疑者,从其呼吸道、泌尿道、消化管、深静脉导管、各种引流管、血液等部位无菌采集标本,送细菌室作细菌、真菌培养,菌种鉴定及药敏试验。
2 结果
2.1 感染率
住院期间感染发生率36.7 %(22/60),发生2例次以上感染者占28.3 %(17/60)。与留置尿管相关的泌尿道感染发病率为9.2 % ,与使用呼吸机相关的肺部感染发病率为36.8 %,与气管切开相关的肺部感染发病率为51.7%。感染部位占前3位的是肺部感染51.7 %(31/60)、胃肠道感染18.3 %(11/60) 和泌尿道感染11.7%(7/60)。
2.2 培养结果
60例98次培养,分离出76株致病菌,仍以革兰氏阴性菌为主,占53.9%(41/76) 。居前3位的是绿脓杆菌26.1 %(25/ 76),真菌13.2 %(10/ 76) ,不动杆菌7.9%(6/ 76) 。
2.3 药敏测试
菌株标本在取材时应用抗生素时间均超过72h,测试前用抗生素超过三种或三种以上占47. 6 %,药敏测试结果显示,G+对大多数常用抗生素有较高的耐药性,仅对万古霉素、利福平敏感;G- 对常用抗生素敏感度均未超过50 %,而对本院不常用的舒普深、特治星等药显示高度敏感。, 百拇医药
[关键词] ICU; 医院感染; 预防
, 百拇医药
[中图分类号] R47 [文献标识码]A [文章编号] 1005-0515(2010)-7-206-02
SEASON ANALYSIS AND PREVENTION ON NOSOCOMIAL DISEASE OF 120 PATIENTS AT ICU
Zhang Xingqun
nursing departmentof luxian traditional Chinese medical hospital
[Abstract]ObjectiveTo explore the epidemic causes ,distribution of pathogen and drug resistance of nosocomial disease at ICU of our hospital and provide evidence of protection to nosocomial disease.Methods 60 patients was collected from January to December in 2008 of ICU,and investage the rate of infection,the epidemic causes and the distribution of pathogen.Results The total incidence of nosocomial disease was 36.7 %; 28.3 % patients of nosocomial disease got infected more than twice. The incidence of catheter related urinary tract infection was 9. 2 % , respirator related lung infection was 36. 8 % and tracheotomy related lung infection was 51.7 %. The top three causes of nosocomial disease were respiratory tract infection (51.7 %) , alimentary infection(18.3%) and urinary tract infection (11.7%) . The leading microrganism cultured was gram-negative bacteria , about 53.9 %. The top three types were Pseudemonas aeruginosa ( 26.1 %) , fungus ( 13.2 %) and acinetobacter (7.9 %) . Conclusion it's high incidence rate of nosocomial disease in ICU. The princeps pathogenic bacteria was gram-negative bacteria;gram-positive bacteria and fungus infection was increasing. The rate of drug resistance was very high. It is advisable to set up the proper surveillance system , rational use of antibiotics and active prevention measures.
, 百拇医药
[Keywords]ICU ;Nosocomial disease ; Prevention
重症监护室获得性感染(nosocomial disease,ND)是指患者进入ICU室72h后继发的感染[1]。因收治的患者病情危重、免疫功能低下及侵入性操作多等原因,医院获得性感染的发生率明显高于普通病房,感染是导致抢救最终失败的最重要原因之一[2]。因此开展ICU住院病人医院感染的监测,了解各类型ICU 获得性感染的发病率及其危险因素,达到有效预防和控制ICU内医院感染的发生,具有极为重要的意义。本文对我院ICU收治的60例患者进行了医院感染监测,并对感染危险因素及致病菌进行分析,提出预防和控制措施。
1 材料与方法
1.1 临床资料
收集我院2008年1月至12月ICU病房60例患者进行观察,男性36例,女性24例,年龄15-65岁,其中涉及疾病包括急性脑血管病13例,急性呼吸窘迫综合征14例,高血压脑出血8例,肺部疾病5例,有机磷农药中毒6例,呼吸心跳骤停复苏后7例,重症胰腺炎7例。住院时间10-65天。
, 百拇医药
1.2 方法
对有院内感染可疑者,从其呼吸道、泌尿道、消化管、深静脉导管、各种引流管、血液等部位无菌采集标本,送细菌室作细菌、真菌培养,菌种鉴定及药敏试验。
2 结果
2.1 感染率
住院期间感染发生率36.7 %(22/60),发生2例次以上感染者占28.3 %(17/60)。与留置尿管相关的泌尿道感染发病率为9.2 % ,与使用呼吸机相关的肺部感染发病率为36.8 %,与气管切开相关的肺部感染发病率为51.7%。感染部位占前3位的是肺部感染51.7 %(31/60)、胃肠道感染18.3 %(11/60) 和泌尿道感染11.7%(7/60)。
2.2 培养结果
60例98次培养,分离出76株致病菌,仍以革兰氏阴性菌为主,占53.9%(41/76) 。居前3位的是绿脓杆菌26.1 %(25/ 76),真菌13.2 %(10/ 76) ,不动杆菌7.9%(6/ 76) 。
2.3 药敏测试
菌株标本在取材时应用抗生素时间均超过72h,测试前用抗生素超过三种或三种以上占47. 6 %,药敏测试结果显示,G+对大多数常用抗生素有较高的耐药性,仅对万古霉素、利福平敏感;G- 对常用抗生素敏感度均未超过50 %,而对本院不常用的舒普深、特治星等药显示高度敏感。, 百拇医药