| ObjectiveTo analyze the clinical application of antibiotics and its pathogen detection in intensive care unit(ICU)with multiple trauma patients,and then provide evidence for improving the success rate of serious multiple traumas,standardizing the collection and submission of microbiological specimens and promoting the rational use of antibiotics.MethodsA retrospective reviewed of multiple trauma cases directly discharged from the intensive care unit of the Second Affiliated Hospital of Zhejiang University from January 2015 to December 2016 was conducted.The antibiotic drugs use,antibiotic de-escalation strategy implementation,microbiological specimen collection and specimen detection of the distribution of pathogens were analyzed.Results1.The rate of antibiotics use in 338 cases of multiple traumas was 93.8%,the average use time of antibiotics was(13,8±13.9)days,the average number of antibiotics used was(2.8±2.2),and the proportion of antibiotics used in combination was 51.8%(175/338).During the entire hospital stay and within the first 3 days of ICU admission,the most commonly used antibiotics were carbapenems and beta-lactam/beta-lactamase inhibitors.The initial use rate of broad-spectrum antibacterial drugs was 51.4%(174/338),and the implementation rate of antibiotics de-escalation strategy was 3.7%(5/135).2.The rate of submission of microbiological specimens in multiple injuries which use antibiotics during hospitalization was 80.8%.Among the cases with microbiological specimens during hospitalization,the rates of microbiological specimens collected within the first 3 days of ICU admission and before the use of the first dose of antibiotics in the ICU were 83.2%and 54.7%.The specimens for inspection were mainly sputum specimens,followed by blood specimens.3.The positive rates of specimens collected during the hospitalization of ICU,the first 3 days of ICU admission,and before the use of the first dose of antibiotics in the ICU were 63.6%,41.6%,and 41.7%.The clinical isolates were mainly Acinetobacter baumannii and coagulase negative staphylococcus,followed by Klebsiella pneumonia and Pseudomonas aeruginosa.4.The positive rates of blood specimens during the hospitalization of ICU,the first 3 days of ICU admission,and before the use of the first dose of antibiotics in the ICU were 52.6%,34.0%,and 33.9%.The results of the culture were mainly coagulase negative staphylococcus.The positive rates of sputum culture were 82.7%,59.8%and 61.9%.The culture results were mainly Acinetobacter baumannii.Conclusion1.The incidence of multiple traumas in intensive care units is high and the use of Antibiotics is long.The use of antibiotics is mainly carbapenems and?-lactams/?-lactamases.2.The use of initial broad-spectrum antibiotics was relatively well,but the implementation rate of antibiotics de-escalation strategy was lower in that case of multiple traumas in the intensive care unit.3.The rate of submit microbiological specimens of intensive care units were low before the use of antibiotics and within the first 3 days of the ICU admission,which the rate of during the hospitalization of ICU was high.The samples submitted for inspection were mainly stained with sputum specimens and other easily-polluted specimens,while specimens of sterile body fluids such as blood and cerebrospinal fluid were relatively few.4.The positive rate of the specimens before the use of the first dose of antibiotics in the ICU,during the first 3 days of ICU admission was relatively low,and the positive rate of culture during the hospitalization of ICU was high.The clinical isolates were mainly contaminating bacteria,such as Acinetobacter baumannii and coagulase negative staphylococcus.pathogenic bacteria,such as Klebsiella pneumonia and Pseudomonas aeruginosa,was relatively few.5.The positive rate of blood cultures was lower than that of sputum specimens in each period.The results of culture of blood specimens and sputum specimens were dominated by contaminating bacteria. |
PDF Full Text Request