某三甲医院2007-2011年ICU气管切开术后肺部感染患者208例临床分析

Pulmonary Infection after Tracheotomy in ICU of a First Class Hospital Between 2007-2011:A Clinical Analysis of 208 Cases

目的:探讨湖南某三甲医院重症监护病房(ICU)患者气管切开后肺部感染病原菌的类型及其耐药性,为临床经验性用药提供帮助。方法:回顾性分析ICU 208例气管切开术后并发肺部感染患者的痰细菌培养及药物敏感性测定结果。结果:共分离出420株致病菌,革兰阴性菌293株,占69.76%,其中铜绿假单胞菌98株居首位;革兰阳性菌105株,占25.24%,其中金黄色葡萄球菌47株为最多;真菌占22株,占5.23%。分离出产超广谱β内酰胺酶(ESBLs)菌87株,耐甲氧西林金黄色葡萄球菌(MRSA)24株。所分离致病菌对常用抗菌药物均有不同程度的耐药,且为多重耐药。结论:ICU气管切开患者肺部感染病原菌以革兰阴性菌为主,耐药率高,临床应加强病原学监测,重视细菌的种类分布和耐药趋势,合理使用抗生素。

Objective： To investigate the types and drug resistance of pathogen of patients from intensive care unit （ICU） with lung infections following tracheal incision, which is helpful for clinical therapy. Methods： 208 patients were complicated with lung infections following tracheal incisions and a retrospective analysis of the bacteria isolates and their resistance to antibiotics was performed. Results： Totally 420 strains of pathogens were isolated by bacterial culture. The Gram-negative bacteria （GNB） isolated were 293 strains （69.76%）, among which the Pseudomonas aeruginosa were 98 strains, which are contributed to the majority, the Gram-positive cocci （GPC） were 105 strains （25.24%）, and the staphylococcusaureus were the most ,47 strains. The fungi isolated were 22 strains, with a proportion of 5.23%. The extended-spectrumβ -lactamases （ESBLs） isolated were 87 strains, and methicillin-resistant staphylococcusaureus （MRSA） were 24 strains. They were resistant to common antibiotics and particularly resistant to a multitude of antibiotics. Conclusions： The major pathogenic microorganisms of the lung infections in patients after tracheal incision in ICU was GNB. The resistance rates to antibiotics of the bacteria were very high. It is advisable that emphasis should be laid on the surveillance of bacterial resistance and rational use of antimicrobial agents in clinical therapy.