ICU危重症患者下呼吸道感染菌群及影响因素分析

摘要:目的　探讨研究ICU危重症患者下呼吸道感染后致病菌的分离情况、菌株的药敏试验结果以及相关影响因素，为指导临床治疗提供基础资料。方法　对某院收治的114例危重症ICU患者下呼吸道感染的标本进行细菌学培养，并对分离出的菌株进行药物敏感试验，同时收集患者的临床治疗资料进行分析。结果　114例危重症ICU患者下呼吸道感染患者中，共培养出细菌102株，真菌2株，病原菌总体分离率为91.23%。其中革兰阴性菌为68株，占66.67%，以肺炎克雷伯菌为主；革兰阳性菌为34株，以表皮葡萄球菌和粪肠球菌为主。药敏试验结果显示，大多数革兰阴性菌对β-内酰胺类抗生素、四环素和复方新诺明耐药，对氨基糖苷类和喹诺酮类等抗生素敏感；而绝大多数革兰阳性菌则对β-内酰胺类和碳氢霉稀类抗生素耐药，对万古霉素等敏感。同时，患者的住院时间、是否进行创伤性操作以及意识障碍等因素是出现下呼吸道感染的危险因素。结论　ICU危重症患者下呼吸道感染病原菌以革兰阴性菌为主要病原体，并且分离出的菌株抗生素敏感性各有不同，在具体临床救治过程中应根据实际情况酌情选择抗生素进行合理治疗。患者的住院时间以及意识障碍等因素是感染发生的危险因素。

Analysis of bacteria and influence factors among ICU critical patients with lower respiratory tract infections

Abstract: Objective The aim of this study was to evaluate the ICU critical patients with lower respiratory tract infection after separation of pathogenic bacteria strains from drug susceptibility test results and the related influencing factors, in order to provide basic data for guiding clinical treatment. Methods From our hospital, 114 severe cases of patients with lower respiratory tract infections in the ICU were studied. The bacteriology training samples, and the strains isolated from the drug sensitive test were analyzed on the patient's clinical information collection. Results Among 114 cases ICU critical patients with lower respiratory tract infection, a total of 102 strains of bacteria and two fungi strains were cultivated. Pathogen overall separation rate was 91.23%, which was suitable for 68 strains of gram-negative bacteria, accounting for 66.67%, mainly Klebsiella pneumonia. Thirty-four strains were Gram-positive bacterium, mainly epidermis staphylococcus and dung enterococcus. Drug susceptibility test results showed that most of the Gram-negative bacteria were resisted to beta lactam antibiotics tetracycline and compound new Ming, and were sensitive to quinolone and aminoglycoside antibiotics. While the vast majority of Gram-positive bacteria were resistant towards beta lactam and hydrocarbon mildew dilute antibiotic, they were sensitive to vancomycin, etc. At the same time, the length of hospital stay for patients with traumatic operation and other factors, such as disturbance of consciousness were risk factors for lower respiratory infection. Conclusion Among ICU critical patients with lower respiratory tract infection, pathogens were mainly Gram-negative bacteria. And isolated strain of antibiotics sensitivity was different. The process of specific clinical treatment should be selected on the basis of the factual situation of antibiotics. Reasonable treatment of the patient's hospital stay and disturbance of consciousness were risk factors for infection.