ICU患者常规气管内吸出物的细菌构成及临床分析

The constitution and clinical analysis of bacteria from patients' routine endotracheal aspirate cultures in ICU

目的调查ICU内危重病人常规气管内吸出物的细菌构成及耐药性,为下呼吸道院内感染的病原学诊断以及合理使用抗生素、有效控制感染提供依据。方法对2002年12月至2005年8月我院ICU106例建立人工气道的患者常规气管内吸出物的细菌培养进行研究,对致病菌菌株的分布及耐药性特点进行分析。结果近3年共检测106例患者送检标本,所分离病原菌共20种165株,其中革兰阳性菌为主占49·1%,革兰阴性菌占39·4%,真菌占11·5%;常见细菌为溶血葡萄球菌、金黄色葡萄球菌、鲍曼/溶血不动杆菌和阴沟肠杆菌;分离病原菌耐药率分析发现,对β内酰胺类抗生素耐药性严重,万古霉素、替考拉宁、亚胺培南耐药率低。结论患者常规气管内吸出物细菌培养结果可作为下呼吸道院内感染病原学诊断的参考依据。在经验性使用抗生素治疗下呼吸道院内感染时,要参考本病区主要致病菌的流行情况和耐药谱。

Objective To investigate pathogens constitution and drug resistance of patients＇routine endotracheal aspirate cultures in ICU. Methods Pathogens distribution and resistance rate of bacilli of 106 patients routine endotracheal aspirate cultures in ICU from Dec 2002 to Aug 2005 were analyzed. Results 165 strains of pathogens from 106 patients samples were separated. Among all the pathogens ,49. 1% of aspirate culture results were gram-negative bacilli ,39. 4% of aspirate culture results were gram-positiv.e bacilli and 11.5% of aspirate culture results were epiphyte. The primary pathogens were Staphylococcus haemolytieus, Staphylococcus aureus, Acinetobacter baumannii and Enterobacter cloacae. Most of bacilli showed high resistance rate to β lactam antibiotics ,and showed low resistance rate to vaneomyein,teieoplanin and imipenem. Conclusions The results of patients＇routine endotraeheal aspirate germieulture can provide reference for the pathogenic diagnosis of lower respiratory tract nosocomial infections. On the empirical antibiotic therapy we should consult the clinical baeteria＇s epidemic situation and antibiotic resistance in ICU.