ICU中建立人工气道后呼吸道获得性感染的临床分析

摘要

Objective：In order to investigate the incidence of hospital acquired respiratory tract infection in the patients with artifical airway in ICU and study the species of pathogenic organism and bacterial drug resistant spectrum and bacterial drug resistant spectrum．Methods: The results drug susceptibility tests in patients with artifical airway from Jan，1998 to Mar．1999 were analyzed，retrospectively．Results: of 43 cultures in 36 patients，the positive rate is 81．4％，30 strains of bacteria 85．7％ and 5 strains of fungus（14．3％）were found in cultures．There were 14 species of bacteria and 2 species of fungs in infection patients．5 cases of patients（14．3％）had mixed infection．The predominant species of Gram（-）bacilli were PS．aeruginos（28．6％）．Acinetobacter baumanii（11．4％）and Enterobacter cloacae （8．6％）．The species of Gram（＋）cocci were S．epideridis（11．4％）and Staphylococcus hemolysis（2．9％）．The resistance rate of Gram（-）bacilli to Penicillin，Quinolone，Amikacini and the third generation Cephalosporins were 75％，42．1％，44．4％and 26．1％，respectively．Conclusion Hospital acquired respirator tract infection control plays a key role in the treatment of critically ill patients with artifical airway．Multi-drug-resist and bacteria and mixed infection are very common．We must pay more attention to the monitory of acquired infection and using antibiotics reasonable．%目的：研究ICU中建立人工气道患者呼吸道获得性感染的发生率、致病菌、药敏和耐药情况。方法：分析1998年1月至1999年3月间，收住本院ICU中建立人工气道患者的呼吸道分泌物的常规培养和药敏资料。结果：36例43次呼吸道分泌物培养阳性35次，阳性率81．4％。其中细菌30株，占85．7％，共14个菌种；霉菌5株，占14．3％，共2个菌种，均为真菌。细菌和真菌混合感染5例，达14．3％。革蓝氏阴性杆菌（G）主要为铜绿假单胞菌（28．6％）、鲍曼氏不动杆菌（11．4％）、阴沟杆菌（8．6％）。革蓝氏阳性球菌（G）主要为表皮葡萄球菌（11．4％）、溶血性葡萄球菌（2．9％）。药敏结果为：对青霉素类、氟喹诺酮类、氨基苷类、头孢三代耐药G杆菌分别达75％、42．1％、40．4％、26．1％，G球菌分别达50％、36．2％、22．5％、15．7％。结论：ICU中建立人工气道患者的呼吸道获得性感染的控制是危重病抢救过程中一个及其重要的环节。由于广谱抗生素的广泛应用，耐药菌株和二重感染日益增多，应用适当抗生素预防和治疗，已成为一个不可忽视的课题。