气道支架置入术后相关肺部感染的病原学分析及抗感染策略

目的：探析气道支架置入术后肺部感染的病原学特点及耐药情况，促进合理用药，为并发肺部感染防治提供参考。方法：选取某医院2015年1月至2016年12月收治的气道支架置入术后肺部感染的58名患者为研究对象，回顾性分析下呼吸道分泌物分离培养的病原菌类型及药敏试验。结果：下呼吸道分泌物培养共分离处51株病原菌，革兰阳性球菌占21.57%，革兰阴性杆菌占70.59%，真菌占7.84%。分离率较高的病原菌为：铜绿假单胞菌31.37%、金黄色葡萄球菌（其中MRSA 2例）19.61%、肺炎克雷伯菌属7.84%、流感嗜血杆菌5.88%、大肠埃希菌5.88%和白色假丝酵母菌5.88%。结论：气道支架置入术后肺部感染的病原菌以革兰阴性菌为主，经验性治疗应主要覆盖铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌属，并结合患者生理病理状态，优化气道支架置入术后相关肺部感染的治疗。

Etiological analysis and anti-infection strategy of pulmonary infection after stent implantation

OBJECTIVE To explore the etiological characteristics and drug resistance of pulmonary infection after stent implantation, and to promote rational drug use, so as to provide reference for the prevention and treatment of pulmonary infection. METHODS Fifty-eight patients with pulmonary infection after airway stent implantation admitted by the hospital from January 2015 to December 2016 were selected as research objects. The pathogen types and drug susceptibility tests of isolated and cultured lower respiratory secretions were retrospectively analyzed. RESULTS There were 51 strains of pathogenic bacteria isolated in the culture of lower respiratory tract secretion, of which 21.57% were G⁺ cocci, 70.59% were G^- bacilli, and 7.84% were fungi. The pathogenic bacteria with high isolation rate were:Pseudomonas aeruginosa 31.37%, Staphylococcus aureus(including 2 cases of MRSA) 19.61%, Klebsiella pneumoniae 7.84%, Haemophilus influenzae 5.88%, Escherichia coli 5.88% and Candida albicans 5.88%. CONCLUSION The pathogenic bacteria of pulmonary infection after airway stent implantation are mainly gram-negative bacteria, and the empirical treatment should mainly cover Pseudomonas aeruginosa, Staphylococcus aureus and Klebsiella pneumoniae. Based on the physiological and pathological status of patients, the treatment of pulmonary infection related to airway stent implantation should be optimized.