46例ICU机械通气患者并发下呼吸道感染病原菌和药敏分析

Investigation on the pathogens of lower respiratory tract infection and on the drug sensitive in 46 patients receiving mechanical ventilation in intensive care unit

目的分析ICU机械通气患者并发下呼吸道院内感染病原学构成和耐药情况。方法采用回顾性调查方法,对46例接受机械通气并发下呼吸道感染患者的下呼吸道分泌物中的致病菌及药敏结果进行分析。用无菌吸痰管或纤支镜采集下呼吸道分泌物,按常规方法送检培养。结果检出致病菌84株,其中G-菌62株(占73.81%),G+菌16株(占19.05%),真菌6株(占7.14%)。前4位致病菌分别为铜绿假单胞菌22株(占26.19%),不动杆菌属16株(占19.05%),肠杆菌属12株(占14.29%),金黄色葡萄球菌10株(占11.91%)。铜绿假单胞菌、不动杆菌属和肠杆菌属均对亚胺培南最为敏感,葡萄球菌对万古霉素最为敏感,上述菌株多重耐药现象严重。结论ICU机械通气患者并发下呼吸道院内感染病原菌以G-菌为主,其药敏试验呈现多重耐药,临床应引起足够重视,开展细菌耐药监测并合理使用抗生素。

Objective To analyze the pathogens of lower respiratory tract infection in patients receiving mechanical ventilation in ICU and the pathogens＇ drug resistance. Methods The pathogens and the drug resistance of lower respiratory tract infection in 46 patients receiving mechanical ventilation and being complicated in ICU were investigated. Results 84 strains pathogens were isolated by bacterial culture. The ratio of the gram-negative bacteria to 62 strains （73.81%） ,and the gram-positive bacteria was 16 strains （19.05%） ,the fungi was 6 strains （7. 14% ）. Among pathogens the most common were P. aeruginosa （ 22 strains） , Acinebacter （16strains） , Entcrobacteriaeeae（12stains） ,S. aureus （10strains）. Imipenem and Cilastatin Sodium was the most sensitive drug for P. aeruginosa, Acinebacter,Enterobacteriaceae. And Vancomycin Hydrochloride was the most for S. aureus. Their drug-resistance-multiple to anti- microbial agents is serious. Conclusions Gram-negatlve bacterial was the majority of the pathogens from patients receiving mechanical ventilation of lower respiratory tract infection in ICU. The pathogens showed multiple drug-resistance in drug sensitive test. It is suggested that there is urgent need for surveillance of bacterial resistance and rational use of anti-microbial agents during the clinical therapy.