重症监护病房气管切开患者下呼吸道感染的病原菌及耐药性研究

Bacteria and Drug Resistance Study of Respiratory Tract Infection for ICU Patients with Tracheostomy

目的了解新建重症监护病房(ICU)气管切开机械通气患者下呼吸道感染率及其感染的病原菌和耐药性,为临床防治提供依据。方法对2006年12月-2007年5月58例ICU气管切开机械通气患者的年龄、基础疾病、合并下呼吸道感染的病原菌构成及耐药率进行分析。结果58例气管切开患者,其中>60岁的老年患者占84.5%,痰液标本培养均检出病原菌,共检出病原菌139株,其中革兰阴性(G-)菌106株占76.3%,革兰阳性(G+)菌26株占18.7%,真菌7株占5%,其中29例患者痰培养出洋葱伯克霍尔德菌,居首位,占病原菌总数的20.7%,G-杆菌的药敏结果显示多药耐药。结论ICU气管切开机械通气引发下呼吸道医院感染病原菌以G-菌为主,临床应重视病原菌的检查,开展病原菌耐药性的监测,合理使用抗菌药物。

OBJECTIVE To investigate the respiratory tract infection rate, pathogenic organism and drug resistance for the patients with tracheotomy and endotracheal incubation in ICU, and to provide first-hand information for diseases prevention and clinical treatment. METHODS Fifty eight patients admitted in our hospital ICU from Dee 2006 to May 2007 were analyzed for their pathogenic organisms of lower respiratory tract infection, drug resistance, underlying diseases and age. RESULTS Pathogenic organisms from sputum culture for 58 patients with traeheotomy and endotraeheal incubation were all positive. A total of 139 strains of pathogenic organisms have been found. Among them 106 were Gram-negative bacteria, accounted for 76.3%, and 26 were Gram-positive bacteria, accounted for 18.7% and 7 were fungi, accounted for 5%. From sputum culture of 29 patients Burk- holderia cepacia was positive, which was the No. 1 bacterial infection, accounted for 20. 7% of total. Drug sensitive test for most Gram-negative bacteria showed resistance. CONCLUSIONS Bacteria infection of respiratory tract of the patients with mechanic ventilation in ICU is mostly Gram-negative. Clinical doctors should emphasize the inspection of pathogenic infection regularly and its drug resistance evaluation, to administer appropriate antibiotics.