| BackgroundInfection is a major problem that patients often face in intensive care unit(ICU).An international epidemiological survey showed that 51%of ICU patients had infections,and infection was an independent risk factor for death of ICU patients.The China HAI Surveillance Network in 2012 pointed out that the prevalence of nosocomial infections in inpatients in China’s comprehensive ICU is high.The ICU received critically ill patients from hospital departments and local hospitals.The condition is complex and serious.Based on various factors,the incidence of ICU patient infection is higher than that of other general departments in the hospital.ICU beds account for less than 10%.However,it accounts for more than 20%of hospital infections.Another characteristic of ICU infection is the high resistance of pathogenic bacteria.The 2012 annual survey of ICU-derived bacterial resistance in tertiary hospitals across the country found that the detection rates of methicillin-resistant Staphylococcus aureus(MRSA)and methicillin-resistant coagulase-negative staphylococci(MRCNS)and extended spectrum beta lactamase(ESBLs)gut bacteria,carbapenem resistant Acinetobacter baumannii,and Pseudomonas aeruginosa were all higher than the national hospital average of the same year].Despite continuous research and development of new high-level antibiotics and their clinical applications,the ICU infection rate and the detection rate of resistant bacteria have not been significantly reduced,and the distribution and resistance rate of pathogenic bacteria have changed over time.ObjectiveThe distribution of pathogenic bacteria and resistance rates often change at different times.Physicians need to improve the treatment of infections in the face of these changes.Therefore,the distribution of ICU pathogens and their drug resistance should be regularly investigated,and the distribution of ICUs and even the distribution of pathogenic bacteria throughout the country in recent years should be known.It is instructive for the ICU doctors to develop antibiotics treatment programs.This paper investigates the pathogenic infections of the ICU in 2008,2012,and 2016 in the Nanfang Hospital,and compares them with relevant data from hospitals and ICUs across the country in order to reveal the distribution of pathogens and changes in drug resistance rates in recent years,and to explore ways to reduce infection rates and resistance of ICU pathogens.MethodsWe retrospectively analyzed the medical records of ICU inpatients from January 2016 to August 2017 in our hospital,collected etiologic data and drug sensitivity results,and statistically analyzed the distribution of pathogens and drug sensitivity test results,and combined the previous related data of 2008 and 2012 to analysis.Results1.Current situation of ICU infection in our hospital:The rate of sample submission and positive detection rate is high;the source of pathogenic bacteria specimens is mainly sputum,which shows that the respiratory infections are serious in our department;the pathogenic bacteria species are mainly G-bacilli,of which Acinetobacter baumanniiand and Pseudomonas aeruginosa are the main components.G.cocci and fungi were the other two major pathogenic species,with the percentages being the same.Enterococcus faecium and Candida albicans were mainly respectively accouted.The ICU pathogen resistance in our hospital is more serious.A variety of pathogenic bacteria appeared multi-drug resistant phenomenon,including multi-drug resistant and pan-resistant Acinetobacter,ESBL-E.coli and ESBL-Klebsiella pneumoniae,MRSA and MRCNS.2.The distribution of ICU pathogens in our hospital changed little in 2008,2012 and 2016.G-bacillus infection accout mainly,and the detection rate of pathogens changed significantly.Acinetobacter baumannii jumped from ninth place in 2008 to first place in 2012 and 2016.Pseudomonas aeruginosa,E.coli showed first decline in the detection rate followed by an increase.It was different with the national ICU present trends.Staphylococcus aureus,Streptococcus pyogenes,and Staphylococcus haemolyticus,which have consistently decreased the detection rate from 2008 to the present,are consistent with the trend exhibited by the national ICU.The detection rates of MRSA and MRCNS in hospitals and ICUs across the country were high,and they tended to decline slowly.In 2008,the detection rate of MRSA and MRCNS in ICU of our hospital was lower than that of national ICU.The detection rate of MRSA decreased first and then recovered.The detection rate of MRCNS continued to rise.In 2016,it was higher than the national hospital level.The detection rate of ESBLs-E.coli and ESBLs-Klebsiella pneumoniae in ICU in our hospital showed a downward trend during the period from 2008 to 2016,which was basically consistent with the trend of hospitals and ICUs in the country.The detection rate of carbapenem-resistant Acinetobacter baumannii in ICUs in our hospital and hospitals and ICUs in the country both showed an upward trend,while the carbapenem-resistant Pseudomonas aeruginosa strains showed a slow decline.In general,the detection rate of ICU is still higher than the overall level of the hospital.Conclusions1.The status of ICU infection in our hospital showed high infection,respiratory infection account mainly,and high detection rate of multiple drug-resistant bacteria.2.The distribution of ICU pathogens in our hospital changed little in 2008,2012 and 2016,with G-bacillus infection as the predominant factor,and the detection rate changed significantly.Acinetobacter baumannii continued to rise to the top,and the detection rates of G+cocci(Staphylococcus aureus,Streptococcus pyogenes,and Staphylococcus haemolyticus)continued to decline,consistent with the trend presented by the national ICU.The detection rate of Pseudomonas aeruginosa and Escherichia coli decreased first and then increased,which is different from the national ICU trend.During the three periods,the detection rate of drug-resistant bacteria increased mainly with MRCNS,carbapenem-resistant Acinetobacter baumannii,Pseudomonas aeruginosa,and Klebsiella pneumoniae.The detection rate decreased with MRSA and ESBL-E.coli and ESBL-Klebsiella pneumoniae.It is basically consistent with the national hospital and ICU trend.3.Low immunity,invasive procedures,past history of antibacterial drugs,and surgical history are important reasons for the high detection rate of drug-resistant bacteria. |
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