非发酵革兰阴性杆菌院内获得性肺炎调查及危险因素分析

Clinical investigation and risk factors analysis on nosocomical pneumonia caused by non-fermentation gram-negative bacilli

目的:了解我院呼吸病房非发酵革兰阴性杆菌所致医院获得性肺炎的现状及其耐药性,为临床医生治疗感染性疾病抗生素的选择提供依据。方法:细菌鉴定采用常规方法,API系统补充鉴定,药敏试验采用纸片扩散法,临床资料采用回顾性分析。结果:非发酵革兰阴性杆菌分离率62%,其中铜绿假单胞菌35. 8%,不动杆菌12. 8%,嗜麦芽窄食单胞菌6. 9%,洋葱假单胞菌6. 4%。临床资料显示高龄、有严重的基础疾病、免疫功能受损、机械通气、曾应用广谱抗生素是非发酵革兰阴性杆菌定植的危险因素。药敏试验显示,本组细菌对头孢菌素耐药率极高,对加酶抑制剂复方制剂、亚胺培南、丁胺卡那、头孢他啶、环丙沙星耐药率较低。结论:非发酵革兰阴性杆菌是院内获得性肺炎的主要致病菌群,其耐药率高、难治性强,建立系统防范措施,合理应用抗生素,控制高危因素是降低其感染发生的重要因素。

Objective: To study the status of non-fermentation gram-negative bacilli which cause nosocomical pneumonia at our department, and give the clinical doctors some advises on the choice of antibiotics. Methods: We identified the bacilli with the routine method and the API system. Drug-sensitive experiences were performed with disk-diffuse method. We analyzed the clinical data in retrospect. Results: The separating rate of non-fermentation gram-negative bacilli was 62%, 35.8% of P. aeruginosa,12.8% of Acinetobacter Baumannii, 6.9% of Stenotrophomas maltophilia, and 6.4% of B.cepacia. Clinical materials demonstrated that senile patients, critical diseases, duration in ICU, immunological dysfunction, tracheal cannula and tracheotomy, and usage of broad-spectrum antibiotics for a long time were the primary risk factors related to the nosocomial infection caused by non-fermentation gram-negative bacilli. Drug-sensitive experiments showed these bacteria had high resistance to cephalosporin and relative low resistance to compound of β lactamase inhibitor, imipenem, amikacin,ceftazidime, and ciprofloxacin. Conclusion: Non-fermentation gram-negative bacilli were the major pathogens, which had high drug-resistance rate and are difficult to control. To decrease the infection rate, we must prevent the infections systemically, use antibiotics reasonably, and control the high risk factors.