口腔颌面外科患者气管切开术后肺部感染的病原学分析及干预对策

Etiological analysis of pulmonary infections in oral and maxillofacial surgery patients after tracheotomy and intervention countermeasures

目的探讨分析口腔颌面外科患者气管切开术后肺部感染的病原学及干预对策,为临床合理使用抗菌药物提供依据。方法回顾性分析医院2007年4月-2013年3月58例行口腔颌面外科气管切开术后肺部感染患者的临床资料,并对患者的痰液进行病原菌培养及药敏试验,同时进行耐药菌检测。结果 58例肺部感染患者送检标本共培养出病原菌120株,其中革兰阴性杆菌占71.7%,革兰阳性球菌占24.2%,真菌占4.2%;前5位的病原菌依次为铜绿假单胞菌、鲍氏不动杆菌、金黄色葡萄球群、肺炎克雷伯菌、大肠埃希菌,分别占10.8%、25.3%、20.0%、13.3%、12.5%;铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌对氨苄西林的耐药率均为100.0%,对头孢唑林、头孢呋辛的耐药率均>70.0%;金黄色葡萄球菌、表皮葡萄球菌对青霉素、氨苄西林、哌拉西林的耐药率均>80.0%,未发现耐万古霉素菌株。结论口腔颌面外科气管切开术后肺部感染以革兰阴性杆菌多见,且耐药性高,采取综合措施加强呼吸道管理、根据培养及药敏结果合理使用抗菌药物,给予临床干预利于肺部感染控制。

OBJECTIVE To explore the etiology of pulmonary infections in the oral and maxillofacial surgery patients after tracheotomy and put forward intervention measures so as to provide basis for reasonable clinical use of antibiotics. METHODS The clinical data of 58 patients with postoperative pulmonary infections who underwent the oral and maxillofacial tracheotomy in the hospital from Apr 2007 to Mar 2013 were retrospectively analyzed, then the sputum culture and the drug susceptibility testing were performed. and the drug-resistant strains were detected. RESULTS A total of 120 strains of pathogens have been isolated from the submitted specimens from the 58 cases of pulmonary infections. among which the gram-negative bacilli accounted for 71. 7 %. the gram-positive cocci 24.2 %. the fungi 4. 2 %; the Pseudomonas aeruginosa , Acinetobacter baumannii , Staphylococcus aureus , Klebsiella pneumoniae , and Escherichia coli ranked the top five species of pathogens, accounting for 10. 8%. 25.3%, 20.0%. 13.3%, and 12. 5 %. respectively. The drug resistance rates of the P. aeruginosa , A. baumannii , and K. pneumoniae to ampicillin were 100.0 %, and the drug resistance rates to cefazolin and cefuroxime were more than 70.0%; the drug resistance rates of the S. aureus and S. epidermidis to penicillin, ampicillin, and piperacillin were more than 80. 0 %; the vancomycin-resistant strains have not been detected. CONCLUSION The gram-negative bacilli are dominant among the pathogens causing pulmonary infections in the patients undergoing the oral and maxillofacial tracheotomy and are highly drug-resistant; it is necessary to take comprehensive measures to strengthen the management of respiratory tract, reasonably use antibiotics according to the results of culture and drug susceptibility testing. and actively carry out clinical interventions so as to control the pulmonary infections.