CAJ | 학술논문

目的调查重症监护病房(ICU)临床微生物标本采样送检和初始抗菌治疗用药情况,为促进抗菌药物合理使用提供依据.方法回顾性调查2012年7月1日至12月31日和2013年7月1日至12月31日从浙江大学医学院附属第二医院ICU出院的所有病例,选取入住ICU时有确切感染证据并在当日接受抗菌治疗病例,对患者感染状况、初始抗菌药物使用、微生物标本送检信息和病原检查结果并进行分析.结果 841例出院病例中,443例入住ICU时有确切感染证据并接受初始抗菌治疗,其中仅30例(6.8％)在初始抗菌治疗前已有病原学送检结果.369例入住ICU时有感染部位的微生物样本可采,360例(97.6％)在入住ICU 3 d内有送检.送检标本以痰最多(占56.4％),其次为血标本17.4％,但仅有119例(33.1％)在首剂抗菌药物使用前完成标本采样.进一步分析接受初始广谱抗菌治疗的269例患者,入住ICU头3d也仅有33.5％病例是在首剂抗菌药物使用前完成标本采样;与使用前采样相比,首剂抗菌药物使用后采样培养的鲍曼不动杆菌、嗜麦芽窄食单胞菌和洋葱伯克霍尔德菌等耐药菌检出率明显升高(P＜0.05);金黄色葡萄球菌、肠杆菌科细菌等检出率在首剂抗菌药物使用前后采样比较差异无统计学意义.结论收住ICU的感染患者初始经验性抗菌治疗前病原学证据缺少,微生物标本送检率虽高但普遍在首剂抗菌药物使用后采样,且以痰等非无菌部位标本为主,降低了病原检查结果的可靠性.
목적 조사중증감호병방(ICU)림상미생물표본채양송검화초시항균치료용약정황,위촉진항균약물합리사용제공의거.방법 회고성조사2012년7월1일지12월31일화2013년7월1일지12월31일종절강대학의학원부속제이의원ICU출원적소유병례,선취입주ICU시유학절감염증거병재당일접수항균치료병례,대환자감염상황、초시항균약물사용、미생물표본송검신식화병원검사결과병진행분석.결과 841례출원병례중,443례입주ICU시유학절감염증거병접수초시항균치료,기중부30례(6.8％)재초시항균치료전이유병원학송검결과.369례입주ICU시유감염부위적미생물양본가채,360례(97.6％)재입주ICU 3 d내유송검.송검표본이담최다(점56.4％),기차위혈표본17.4％,단부유119례(33.1％)재수제항균약물사용전완성표본채양.진일보분석접수초시엄보항균치료적269례환자,입주ICU두3d야부유33.5％병례시재수제항균약물사용전완성표본채양;여사용전채양상비,수제항균약물사용후채양배양적포만불동간균、기맥아착식단포균화양총백극곽이덕균등내약균검출솔명현승고(P＜0.05);금황색포도구균、장간균과세균등검출솔재수제항균약물사용전후채양비교차이무통계학의의.결론 수주ICU적감염환자초시경험성항균치료전병원학증거결소,미생물표본송검솔수고단보편재수제항균약물사용후채양,차이담등비무균부위표본위주,강저료병원검사결과적가고성.
Objective To explore specimen sampling for microbial culture in ICU patients with documented infections in order to offer clinical evidence for improving the rational use of antibiotics.Methods Patients with documented infection on the first day after admission into ICU and discharged from ICU from July to December 2012 and from July to December 2013 were enrolled in the study.Clinical data including presence or absence of infection,initial antimicrobial therapy,microorganism specimen sampling and culture were retrospectively analyzed.Results Of 841 patients discharged from ICU,443 had evidence of infections and received antimicrobial therapy on the admission day,and only 30 (6.8％) of them had microbiological detection results prior to treatment.There were microbial specimens available at infection sites on the admission day in 369 cases,and 360 cases (97.6％) of them were sampled in the first three days after ICU admission,while only 119 cases (33.1％) were sampled before the first dose of antimicrobial therapy.Specimens sampled were sputum (56.4％) in the majority,followed by the blood (17.4％).Further analysis of 269 infected patients receiving initial broad-spectrum antimicrobial therapy also showed that only 33.5％ cases were sampled before the first dose of broad-spectrum antimicrobial administration.The positive isolation rate of multi-drug resistant isolates including A.baumannii,S.maltophilia and B.cepacia from specimens sampled after first dose of initial broad-spectrum antimicrobial therapy were significantly higher than those sampled before antimicrobial therapy,P ＜ 0.05.There was no significant difference in isolation rate of Staph.aureus and Enterobacteriaceae between samples obtained before and after first dose of initial broad-spectrum antimicrobial therapy.Conclusions Few evidence of pathogenic microorganisms was available before initial antimicrobial therapy in ICU patients.Although sampling rate of microbial specimens is high,the most of them are sampled after the first dose of antimicrobial administration,and the patentially contaminated specimens such as sputum in predominance,obviously decrease the reliability of authentic results obtained from microorganism culture.