ICU老年感染性休克患者抗感染治疗前后痰病原菌培养变化对比分析

Change of sputum culture for pathogens in elderly patients with septic shock in ICU before ad after anti-infection therapy

目的了解ICU老年感染性休克患者抗感染治疗前后痰病原菌的变化,为临床治疗提供参考。方法选择医院2011年1月-2013年1月52例ICU老年感染性休克患者,入ICU时及治疗后1、2、4周均进行痰病原菌培养,动态观察治疗前后细菌定植的变化,根据患者预后分为存活组与死亡组,比较两组治疗前病原菌构成差异。结果治疗前有39例患者痰培养为阳性,阳性率为75.0%;共分离病原菌44株,以革兰阴性杆菌为主,占77.27%,治疗后4周,余20例患者在ICU继续治疗,痰培养阳性率100.0%,病原菌的构成发生了一定的变化,革兰阴性菌的构成比例上升至92.59%,与治疗前比较差异有统计学意义(P<0.05);治疗1、2、4周细菌清除率分别为43.18%、50.00%、83.93%%;存活组肠杆菌属、革兰阳性菌、其他菌属构成比例明显高于死亡组,死亡组非发酵菌构成比例显著高于存活组,组间比较差异有统计学意义(P<0.05)。结论 ICU老年感染性休克患者治疗前后病原菌的构成有明显变化,革兰阴性杆菌明显升高,且死亡组患者治疗前定植菌以高度耐药的非发酵菌为主,加强对耐药菌株的监测,合理使用抗菌药物是提高细菌清除率的重要措施。

OBJECTIVE To understand the change of distribution of pathogens cultured from sputum of elderly patients with septic shock in ICU so as to provide guidance for clinical treatment.METHODS A total of 52elderly patients with septic shock,who were treated in ICU from Jan 2011to Jan 2013,were enrolled in the study,then the culture of sputum specimens was performed at the admission to ICU,or week 1,week 2,or week 4after the treatment,the dynamic change of bacterial colonization was observed before and after the treatment,the subjects were divided into the survival group and the death group according to the prognosis,and the difference in the distribution of the pathogens was observed and compared between the two groups before the treatment.RESULTS Before the treatment,the sputum specimens were cultured positive in 39cases with the positive rate of 75.0%.Totally 44strains of pathogens have been isolated,among which the gram-negative bacilli were dominant,accounting for 77.27%.Four weeks after the treatment,20remained cases continued to receive treatment in ICU,the positive rate of sputum culture was 100.0%,the constituent ratios of the pathogens changed to a certain degree,the constituent ratio of the gram-negative bacteria increased to 92.59%,as compared with that before the treatment,the difference was significant（P＆lt;0.05）.The bacterial clearance rate was 43.18% at week 1after the treatment, 50.00%at week 2after the treatment,83.93%at week 4after the treatment.The constituent ratio of the Enterobacteriaceae,gram-positive bacteria,or other genera was significantly higher in the survival group than in the death group;the constituent ratio of the non-fermenting bacteria was significantly higher in the death group than in the survival group（P＆lt;0.05）.CONCLUSION The constituent ratios of the pathogens isolated from the elderly patients with septic shock in ICU have changed significantly before and after the treatment,the constituent ratio of the gram-negative bacilli is significantly increased;the non-fermenting bacteria that are highly drug-resistant are the predominant colonized bacteria isolated from the patients in death group.It is necessary to strengthen the surveillance of drug-resistant strains and reasonably use antibiotics so as to raise the bacterial clearance rate.