气管插管和气管切开术后下呼吸道感染病原菌分析

目的分析气管插管和气管切开并发下呼吸道感染相关因素及致病菌分布和耐药特征,为临床治疗提供依据。方法对本院2005年1月至12月59例气管插管和气管切开并发下呼吸道感染病人进行回顾性调查。结果59例患者共分离出145株致病菌,主要为革兰阴性杆菌,占77.9%,革兰阳性菌占17.9%,以鲍曼不动杆菌、铜绿假单胞菌和凝固酶阴性葡萄球菌为主;21株葡萄球菌中15株为甲氧西林耐药的葡萄球菌,表现为对苯唑西林、氨基糖苷类、四环素、红霉素、氟喹诺酮类等高度耐药,对利福平耐药率低,未发现耐万古霉素菌株。肠球菌对青霉素、氨苄西林耐药率低,未见耐万古霉素菌株。肠科杆菌中大肠埃希菌和肺炎克雷伯菌对第三代头孢菌素耐药率高,铜绿假单胞菌和鲍曼不动杆菌对大多数抗菌药物耐药。术后48 h~7d发生下呼吸道感染,占57.6%,7 d以上占22.0%。结论气管插管和气管切开易并发下呼吸道感染,多发生在48h~7d,致病菌以革兰阴性杆菌为主,多为多重耐药菌株。

Bacteriologic analysis on infection of lower respiratory tract after intubations and tracheotomy

Aim To analyze the factors relating to lower respiratory tract infection after tracheal intubations and tracheotomy,distribution of pathogen,and characteristics of drug-resistance to provide evidences for clinical treatment.Methods A retrospective survey has been made of 59 patients whose lower respiratory tracts were infected after tracheal intubations and tracheotomy during Jan.to Dec.of the year 2005.Results 145 strains of pathogen were separated from 59 patients,the major pathogens of which were gram negative bacteria(77.9%);gram positive bacteria,17.9%,especially acinetobacter baumann,pseudomonas aerations and coagulate negative staphylococcus of 21 strains of staphylococci.There are 15 strains of mythically-resistant staphylococci,which are strongly drug-resistant to benzimidazole,aminoglycoside,tetracycline,erythromycin,but weakly drug-resistant to rifampicin,drug-resistant vancomycin not found.Enterococcus has weakly drug-resistant rate against penicillin and magically,drug-resistant vancomycin not found.Of enterobacteriaceae,escherichia coli and klebsiella pneumonia have strongly drug-resistant rate against the cephalosporin of the third generation.Pseudomonas aerations and acinetobacter baumann are drug-resistant to most antibacterial medicines.Within 48 hours to 7 days after the operation,lower respiratory tracts are infected,accounting for 57.6 %;above 7 days,22%.Conclusions The infection mentioned above takes place mostly within 48 hours to 7 days.The major pathogens are gram negative bacilli,which are resistant to several medicines.