气管切开机械通气病人获得性气道感染病原体分布与体外耐药性监测

Pathogen distribution and bacterial resistance of clinical isolates from patients with acquired respiratory tract infection after tracheotomy for mechanical ventilation

目的 探讨综合性ICU内机械通气病人获得性呼吸道感染的病原菌分布特征与体外耐药情况。方法 分析 1997年 1月至 2 0 0 2年 6月间我院综合性ICU 176例气管切开机械通气病人呼吸道分泌物细菌培养与药敏资料。结果 176例病原菌以革兰阴性菌占绝对优势 (72 0 9% ) ,革兰阳性菌占 17 80 % ,真菌占 9 4 5 %。革兰阴性菌中以铜绿假单胞菌居首位 (2 5 71% ) ,肺炎克雷伯菌 (7 0 3% ) ,大肠埃希菌(6 81% ) ,鲍曼氏复合醋酸钙不动杆菌 (6 37% ) ,阴沟肠杆菌 (5 2 7% )和嗜麦芽窄食假单胞菌 (5 0 6 % )。肠杆菌科细菌、铜绿假单胞菌、不动杆菌属和肠球菌属均对亚胺培南最为敏感 ;嗜麦芽窄食假单胞菌对亚胺培南的耐药率高达 87 5 0 % ,而耐药率最低的环丙沙星也已出现了 4 1 6 7%的耐药株 ;葡萄球菌属对万古霉素最敏感 ,但肠球菌属对万古霉素的耐药株已经达到 36 11% ,金黄色葡萄球菌对亚胺培南也有 80 %的敏感率 ;大肠埃希菌对头孢替坦、阿米卡星、呋喃唑酮仍较敏感 ;各类细菌对三代头孢和喹诺酮类均有较高的耐药率。

Objective To study the pathogen distribution and bacterial resistance of clinical isolates from acquired respiratory tract infection of patients after tracheotomy for mechanical ventilation in the gereral ICU.Methods The bacterial culture and drug sensitivity assays of 176 patients after tracheotomy for mechanical ventilation were analyzed.Results Among total pathogenhs,Gram's negative bacteria accounted for 72.09%,Gram's positive bacteria 17.80%,fungi 9.45% respectively.Gram's negative bacteria mainly included P.Aweruginosa(25.71%),K.Pneumoniae(7.03%),E.Coli(6.81%),A.Baumannii(6.37%),E.Sloacae(5.27%) and X.Maltophilia(5.06%).The sensitivity of Enterobacteriaceae,P.Aeruginosa,Acinetobacter and Enterococcus to imipenem was the highest.The resistancy of X.Maltophilia to imipenem and ciprofloxiacin was 87.50% and 41.67% respectively.The sensitivity of Staphylococcus to vancomycin was the highest,but the resistancy of Enterococcus to vancomycin had already reached to 36.11%.E.coli was still sensitive to cefotetan,amikacin and nitrofurantoin.The resistancy of nearly all bacteria to 3rd generation cephalosporin and 3rd generation quinolone was higher.Conclusion Acquired respiratory tract infetion of patients aftre opening tracheas for mechanical ventilation in the gerneral ICU is a severe problem encountered in treating critical patients.Bacterial resistance or cross resistance are more and more popular in ICU,which is the difficulty of anti infective treatment.Abuse of antibiotics is one of the important reasons leading to bacterial resistance or cross resistance.