气管切开与非气管切开患者肺部感染病原菌分布及耐药率比较分析

目的 探讨气管切开与非气管切开患者肺部感染的病原菌分布及耐药率。方法 收集2014年1~12月中国人民解放军海军总医院高压氧科气管切开与非气管切开肺部感染患者的送检痰标本,采用法国梅里埃全自动微生物分析仪进行菌种鉴定和药物敏感性试验,对其病原菌分布及耐药率进行比较。结果 气管切开患者的肺部感染检出病原菌前10位依次为铜绿假单胞菌、鲍曼不动杆菌、奇异变形杆菌、肺炎克雷伯菌、黏质沙雷菌、大肠埃希菌、金黄色葡萄球菌、白色假丝酵母菌、表皮葡萄球菌和溶血葡萄球菌,分别占25.3%、13.8%、12.8%、11.7%、11.1%、8.2%、5.9%、5.6%、1.7%和1.5%;非气管切开患者的检出病原菌前10位依次为鲍曼不动杆菌、铜绿假单胞菌、白色假丝酵母菌、溶血葡萄球菌、肺炎克雷伯菌、恶臭假单胞菌、大肠埃希菌、热带假丝酵母菌、金黄色葡萄球菌和表皮葡萄球菌,分别占21.1%、20.5%、15.1%、12.9%、6.0%、5.8%、4.7%、4.1%、3.3%和3.3%。铜绿假单胞菌在气管切开患者中对头孢哌酮/舒巴坦较为敏感,而在非气管切开患者中对多黏菌素B较为敏感,耐药率都小于25.0%;所有患者均出现耐亚胺培南铜绿假单胞菌(IRPA)。鲍曼不动杆菌的耐药率均较高,但在气管切开患者中,阿米卡星、多黏菌素B、左氧氟沙星的耐药率稍低。气管切开与非气管切开患者中真菌感染均以白色假丝酵母菌居首位,但非气管切开患者中真菌类型和感染率较高。结论 气管切开与非气管切开患者的肺部感染病原菌分布和耐药率有明显区别,临床应根据药敏合理使用抗菌药物,加强呼吸道管理,防止医院感染,以利于肺部感染控制。

Distribution and drug resistance of pneumonia pathogens in patients with tracheotomy and non-tracheotomy：a comparative study

Objective To explore the distribution and drug resistance rates of pneumonia pathogens in patients with tracheotomy and non-tracheotomy .Methods The sputum specimens of patients with tracheotomy and non-tracheotomy who got pulmonary in-fection in hyperbaric oxygen department from Jan to Dec 2014 were collected ,and then performed the bacterial identification and drug susceptibility testing by automatic microbiology analyzer .The data were statistically analyzed with the SPSS19 .0 software .Re-sults The top ten species of pathogens isolated from patients with tracheotomy included Pseudomonas aeruginosa(25 .3% ) ,Acine-tobacter baumannii(13 .8% ) ,Singular proteus(12 .8% ) ,Klebsiella pneumonia(11 .7% ) ,Serratia marcescens(11 .1% ) ,E .coli pin (8 .2% ) ,Staphylococcus aureus (5 .9% ) ,White candida(5 .6% ) ,epidermis staphylococcus (1 .7% )and Hemolysis staphylococcus (1 .5% ) ,while the top ten species of pathogens isolated from patients with non-tracheotomy were Acinetobacter baumannii (21 .1% ) ,Pseudomonas aeruginosa(20 .5% ) ,White candida (15 .1% ) ,Hemolysis staphylococcus (12 .9% ) ,Klebsiella pneumonia (6 .0% ) ,stench of pseudomonas(5 .8% ) ,E .coli pin(4 .7% ) ,Tropical candida(4 .1% ) ,Staphylococcus aureus(3 .3% )and epidermis staphylococcus(3 .3% ) .Pseudomonas aeruginosa was more sensitivity to Cefoperazone/shu tan in patients with tracheotomy ,while more sensitivity to polymyxin B in respiratory department ,the drug resistant rate both less than 25 .0% .Imipenem-resistant Pseud-omonas aeruginosa was founded in all patients .The drug resistant rate of Acinetobacter baumannii were high ,but it was lower to amikacin ,polymyxin B and ofloxacinDin patients with tracheotomy .The white candida was the most common species of Fungal in-fection ,but the species and infection rate of Fungal were higher in patients with non-tracheotomy .Conclusion It is significant dif-ferent on distribution and drug resistance of pneumonia pathogens in patients with tracheotomy and non-tracheotomy .It is necessary to choose the antibiotics rationally according to the drug susceptibility testing ,strength the airway management and avoid the hospi-tal infection .