ICU老年患者气管切开后的痰病原菌培养与药敏分析

Culture of pathogenic bacteria from sputum of ICU senile patients after tracheotomy and drug Sensitivity analysis

目的探讨ICU老年患者气管切开后痰病原菌的种类与分布及其对抗菌药物的敏感性,为临床合理使用抗菌药物提供依据。方法将2007年5月-2009年12月在医院ICU住院的96例老年患者气管切开后的痰标本进行病原菌学分离、鉴定,并对药敏结果进行统计分析。结果主要病原菌以革兰阴性菌为主,包括铜绿假单胞菌(24.3%)、鲍氏不动杆菌(20.8%)、肺炎克雷伯菌(13.2%)、大肠埃希菌(6.6%),对亚胺培南高度敏感;革兰阳性菌以金黄色葡萄球菌为主(12.1%),对万古霉素未发现耐药菌株;真菌以白色假丝酵母菌为主(9.4%),两性霉素B治疗有效。结论 ICU老年患者气管切开后的痰病原菌培养以革兰阴性菌为主,临床上应依据药敏结果合理使用抗菌药物,同时需加强消毒、隔离及护理工作。

OBJECTIVE To investigate the distribution of pathogenic bacteria in sputum and its susceptibility to antimicrobial in elderly ICU patients after tracheotomy in order to provide a reasonable basis for clinical use of antimicrobial agents. METHODS The pathogenic bacteria of sputum samples were isolated and identified in 96 patients with ICU hospitalized elderly patients after tracheotomy from May 2007 to December 2009 in our hospital, and susceptibility results were analyzed statistically. RESULTS The main pathogens were gram-negative bacteria, including Pseudomonas aeruginosa （24.3 % ）, Acinetobacter spp （20.8% ）, Klebsiella pneumoniae （13.2%）, and Escherichia coli （6.60%）, which were highly sensitive to imipenem. Gram-positive bacteria Staphylococcus aureus （12.15%）, no vancomyein-resistant strain was found. C. albicans was the major fungus （9.36 %）, amphotericin treatment was effective. CONCLUSION Gram-negative bacteria are the main pathogenic bacteria isolated from putum samples in ICU elderly patients after tracheotomy. The clinical use of antimicrobial drugs should be based on the drug susceptibility results, meanwhile, it is necessary to strengthen the disinfection, quarantine and care.