气管切开术后下呼吸道感染病原菌及耐药性分析

目的探讨气管切开术后下呼吸道感染的病原菌分布，并分析其耐药性。方法回顾性分析2010年2月～2011年2月我院气管切开术后下呼吸道感染69例病人的临床资料。结果65例病人共检出病原菌89株，以革兰阴性菌为主，检出率最高的依次为铜绿假单胞菌（14．6％）、肺炎克雷伯菌（10．1％）、大肠埃希菌（7．9％）及鲍曼不动杆菌（7．9％）。革兰阳性菌对青霉素、克林霉素、阿奇霉素、诺氟沙星耐药率较高；革兰阴性菌对喹诺酮类、大环内酯类、青霉素类药物耐药率较高；真菌对常用抗真菌药物耐药性均较高。初始治疗有效者占68．5％，初始治疗用药与药敏试验不符、效果不佳更换抗菌药物者占31．5％。结论气管切开术后下呼吸道感染的病原菌较为多样，需要进行严格的病原菌检测和药敏试验，以指导临床合理用药。

DISTRIBUTION AND DRUG RESISTANCE OF PATHOGEN IN LOWER RESPIRATORY TRACT INFECTION AFTER TRACHEO- TOMY

Objective To investigate the distribution and drug resistance of pathogen in lower respiratory tract infection （LRTI） after tracheotomy. Methods A retrospective review was done for clinical data in 69 cases of LRTI after tracheotomy performed during Feb. 2010-Feb. 2011. Results A total of 89 strains of disease producing germ were detected, mainly Gram negative bacteria, the highest detection rate being Pseudomonas aeruginosa （14.6 % ）, followed by klebsiella pneumoniae （10.1%）, Eseherichia （ 7.9 % ） and Acinetobaeter haumannii （7.9 %）. A highly resistant rate to penicillin, elindamycin, azithromycin, nor floxacin was found in Gram positive bacteria, and Gram-negative ones were mostly resistant to quinolones, macrolides, and penicil- lins. Fungi were highly resisted to commonly-used antifungal agents. The effective rate of initial treatment was 68.5%. For those with poor efficacy in the initial therapy, because of inconsistent with the drug sensitive test, and thus were changed to alternative medicine accounted for 31.5%. Conclusion The pathogen of post-tracheotomy LRTI are various, a strict inspection of pathogenic germ and drug sensitive test are required for guiding a reasonable clinical medication.