ICU重症感染老年患者抗感染治疗前后痰细菌培养结果动态变化观察

Dynamic changes of etiological agents in specimens of sputum in elderly patients with respiratory tract severe infections in ICU

目的了解ICU患者痰检病原学分布和抗菌药物治疗后痰菌的动态变化及与临床疗效的关系。方法采用回顾性调查方法,对2008年6月-2011年4月收治的49例重症下呼吸道或肺部感染患者痰培养结果进行分析,并观察抗感染治疗后痰细菌培养结果动态变化。结果 49例患者入ICU时痰菌培养阳性率为59.2%,治疗后1、2周痰菌培养阳性率分别为83.7%、90.2%,治疗后3、4周痰菌培养阳性率均为100.0%;早期痰培养以假丝酵母菌属、铜绿假单胞菌、肺炎克雷伯菌、革兰阳性球菌及嗜麦芽寡养单胞菌为常见病原菌,后期铜绿假单胞菌、鲍氏不动杆菌、嗜麦芽寡养单胞菌等非发酵菌占绝对优势;抗感染治疗后假丝酵母菌属、革兰阳性球菌、肠杆菌属清除率高,对非发酵菌清除率低。结论随着患者住ICU时间的延长,患者下呼吸道细菌定植感染率明显增加,以非发酵菌为主;多种预后相关因素分析提示肾功能不全是ICU重症患者独立的致死危险因素,应进一步认识ICU重症患者气道痰菌培养的意义及抗菌药物使用的合理性,积极预防各种因素导致的急性肾功能不全。

OBJECTIVE To investigate the distributions of etiological agents in specimens of sputum in the patients with the lower respiratory tract infections and dynamic changes after antibiotics administration. METHODS A total of 49 patients were retrospectively surveyed, with lower respiratory tract infections when admitted. Specimens of sputum were collected prior and post to antibiotic therapy. The causative organisms were identified by the routine technique. RESULTS The positive rates of the sputum specimens from the 49 patients were 59.2% ,83.7%, and 90.2% on the first day, first week and second week after antibiotic therapy, respectively. Both the positive rates of the sputum specimens after 3 and 4 weeks antibiotic therapy were 100.0%. The most common bacteria during early stage cultures were Candida albicans, Pseudornonas aeruginosa, Klebsiella spp, gram-positive cocci, and Stenotrophomonas maltophilia. While P. aeruginosa, Acinetobacter baumannii and S. maltophilia were frequently detected at late stage. CONCLUSION The positive rates of the sputum specimens increase significantly with the extension of time. multi-factor prognostic analysis suggests renal insufficiency is an independent death risk in the ICU. Cultivation and rational use of antibiotics are important. Active measures should be taken for the prevention of acute renal insufficiency.