人工气道患者肺炎病原菌分布及耐药情况分析

Investigation of pathogens distribution and drug resistance in pneumonia patients with artificial airway

目的:分析ICU人工气道患者肺炎病原菌感染情况及其耐药情况。方法:2005年3-9月间入住我院ICU行气管插管或气管切开并诊断为肺炎的患者的下呼吸道分泌物进行培养、分离鉴定及药物敏感性实验。结果:23例患者中16例两次或多次罹患肺炎,送检痰液标本检出菌株333株次,其中G-菌259株(占77.8%),包括铜绿假单胞菌、嗜麦芽窄食菌、鲍曼不动杆菌等;48株G+菌中47株为耐甲氧西林的金黄色葡萄球菌(MRSA);真菌26株,占7.8%。G-菌对抗生素的敏感性差异较大,感染率前四位者耐药率高;MRSA对万古霉素100%敏感。结论:人工气道患者肺炎的罹患率高,二重感染率高,感染细菌耐药率高,应当合理使用抗生素,更应积极治疗原发疾病,及时去除人工气道。

Objective To investigate spectrum distribution of pathogens in pneumonia patients with artificial airway and to analyze its drug resistance. Methods The clinical data of 23 patients with tracheal intubation or tracheotomy from March 2005 to September 2005 were chosen as study targets when they acquired pneumonia. Secretions aspirated from the patients＇ low respiratory tract were collected and classified, and drug sensitivity results were anaylized. Results Sixteen patients were diagnosed as pneumonia twice or more. Three hundred and thirty-three isolates of pathogens were totally collected, of which the most were gram negative （G^-） bacilli （259/333, 77.8%）, including Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and Acinetobacter baumannii, etc. In 48 isolates of gram positive colli （G^＋）, there were 47 isolates of MRSA（47/333,14.1%）. Fungus were 27 isolates（27/333,7.8%） in all. The resistant rates to drugs of the four most G^- pathogens were high. MRSA was sensitive to vancomycin fully. Conclusions Patients who have artificial airways have a higher morbidity of pneumonia,the higher the risk of superinfection of pathogens, the higher the resistant rates to multiple drugs. Antibotics should be used correctly, but it is more important that primary disease should be treated positively so that artificial airway can be moved early.