有创机械通气患者气囊上滞留物病原菌分布及耐药性研究

Distribution and drug resistance of pathogens in subglottic secretion from traumatic mechanical ventilation

目的研究机械通气(MV)患者气囊上滞留物、下呼吸道分泌物的病原菌分布及其耐药性分析,为临床抗菌药物的正确应用提供参考。方法对ICU机械通气患者使用可吸引导管进行气囊上滞留物引流的患者进行目标性监测,病原学检查和进行药物敏感试验,并对细菌的构成比,耐药性进行分析。结果 98例行气囊上滞留物间歇吸引的患者,其中气囊上滞留物共检出病原菌186株,其中革兰阴性菌主要优势菌株为铜绿假单胞菌占25.8%,鲍氏不动杆菌占17.7%,肺炎克雷伯菌占15.1%,革兰阳性菌株以金黄色葡萄球菌为主占9.1%,不同病原菌对抗菌药物的多药耐药率均较高,但不同的抗菌药物耐药率差异较大,下呼吸道检出病原菌169株,与气囊上滞留物病原菌分布及耐药性相似,差异无统计学意义。结论 VAP患者气囊上滞留物和下呼吸道分泌物病原菌分布以革兰阴性杆菌为主,均存在多药耐药;气囊上滞留物与下呼吸道分泌物病原菌的一致性、耐药性相似,因此临床上应加强抗菌药物的合理应用。

OBJECTIVE To research the distribution of pathogenic bacteria and their drug sensitivity of lower respiratory tract and subglottic secretion in mechanical ventilation,MV sufferers.METHODS Objective surveillance was performed,pathogenic diagnosis and testing sensitivity in those ICU mechanical ventilation patients,who used suction catheter to drainage subglottic secretion,analyze the distribution and drug sensitivity of pathogenic bacteria.RESULTS In 98 patients,186 kinds of bacteria,169 of which existed in lower respiratory tract,exist in their subglottic secretion,and in Gram-negative bacilli pseudomonas was the dominance： 25.8%,Acinetobacter baumannii 17.7%,Klebsiella pneumoniae 15.1%.in Gram-positive Bacteria,Staphylococcus aureus was the dominant one,9.1%.the drug sensitivity of different pathogenic bacteria were commonly high but varies.There were no statistic significant in the distribution and drug sensitivity of pathogenic bacteria both in lower respiratory tract and in subglottic secretion.CONCLUSION The dominant pathogenic bacteria both in ower respiratory tract and in subglottic secretion of ventilator associated pneumonia,VAP is Gram-negative bacilli,and all pathogenic bacteria are drug-fast.so we should enhance the management of antibiotic application.