标题：ICU内重症创伤感染者病原菌及耐药菌的分布

      作者：杨俊 1，马华兰 2，谭淑英 1，陈麒麟 1    (重庆市黔江中心医院急诊科 1、检验科 2，重庆 409099)

      卷次： 2017年28卷20期

      【摘要】 目的 调查研究 ICU内重症创伤感染者病原菌及耐药菌的分布。方法 对2015年1月至2016年6月来源于重庆市黔江中心医院 ICU内重症创伤感染患者的标本进行细菌培养，并回顾性分析药敏试验结果。结果 革兰氏阴性杆菌占比为 65.50% (131/200)，高于革兰氏阳性杆菌的 11.50% (23/200)以及真菌的 23.00% (46/200)，而真菌占比又高于革兰氏阳性杆菌，差异均有统计学意义(均P<0.05)。其中革兰氏阴性杆菌主要包括鲍氏不动杆菌、肺炎克雷伯菌、大肠埃希菌及铜绿假单胞菌，而革兰氏阳性菌主要包括金黄色葡萄球菌、屎肠球菌与粪肠球菌。鲍氏不动杆菌的耐药率最高，均在60.00%以上，而铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌对哌拉西林/他唑巴坦、亚胺培南、阿米卡星具有较好的敏感性。屎肠球菌、粪肠球菌、金黄色葡萄球菌对万古霉素的耐药性分别为22.22% (2/9)、0 (0/5)、0 (0/4)。结论 ICU内重症创伤感染者病原菌主要为革兰氏阴性杆菌，且耐药较为严重，临床医师应根据耐药性调整抗菌药物的使用，以减缓病原菌对抗菌药物产生耐药。
      【关键词】 重症创伤感染；病原菌；耐药性
      【中图分类号】 R641 【文献标识码】 A 【文章编号】 1003—6350（2017）20—3337—03

Distribution of pathogens and drug resistance of bacteria in severe trauma patients at ICU.
YANG Jun 1, MAHua-lan 2, TAN Shu-ying 1, CHEN Qi-lin 1. Department of Emergency 1, Department of Clinical Laboratory 2, ChongqingQianjiang Central Hospital, Chongqing 409099, CHINA
【Abstract】 Objective To study the distribution of pathogens and drug resistance of bacteria in severe trau-ma patients at ICU. Methods From January 2015 to June 2016, the specimens from patients with severe trauma inour hospital ICU was isolated for bacterial culture, and drug susceptibility test results were retrospectively analyzed.Results The proportion of Gram-negative bacilli was 65.50% (131/200), which was significantly higher than 11.50%(23/200) for Gram-positive bacillus, and 23.00% (46/200) for fungi, and the differences between the three types ofpathogens were significant (all P<0.05). Gram-negative bacillus mainly included Boydii acinetobacter, Klebsiella pneu-moniae and E. coli and Pseudomonas aeruginosa, while Gram-positive bacteria mainly included Staphylococcus aureus,Enterococcus faecium, and Enterococcus faecium. Acinetobacter baumannii had the highest resistance rate, more than60.00%, and Pseudomonas aeruginosa, Klebsiella pneumoniae and E. coli had better sensitivity to piperacillin-tazobac-tam, imipenem, amikacin. The resistance rates of Enterococcus faecium, and Enterococcus faecium, Staphylococcusaureus to vancomycin were 22.22% (2/9), 0 (0/5), 0 (0/4), respectively. Conclusion The infection pathogenic bacte-ria in ICU for severe trauma are mainly Gram-negative bacilli, and resistance is relatively serious, Clinicians shouldadjust the use of antimicrobial drugs according to drug resistance to slow the pathogen resistance to antimicrobialagents.
      【Key words】 Severe wound infection; Pathogenic bacteria; Drug resistance·论 著·doi:10.3969/j.issn.1003-6350.2017.20.023基金项目：重庆市卫生计委医学科研项目（编号：2015MSXM134）