气管切开术后肺部感染的病原学分析及防治

目的 归纳总结气管切开术后肺部感染的病原学特点。方法 回顾我院气管切开术后发生肺部感染的245例患者资料，对其痰细菌培养、药敏试验结果及临床资料进行分析。结果 气管切开患者发生肺部感染率为83.6%；共分离出334株病原菌，G-杆菌224株占67.1%。感染率最高的病原菌依次为:铜绿假单胞菌(23.4%)、金黄色葡萄球菌(17.4%)、克雷伯氏菌属(11.7%)、不动杆菌属(10.5%)、大肠埃希菌(9.6%)。药敏结果显示:所选抗菌药物中,对G-杆菌敏感性较高的药物有亚胺培南(73.7%),哌拉西林/他唑巴坦(61.1%), 对G+球菌敏感性较高的药物有万古霉素(100%)，呋喃妥因(92．9%)。 产超广谱β 内酰胺酶的G-菌和耐甲氧西林的金黄色葡萄球菌出现的耐药率呈现上升趋势(P＜0.05)。结论 气管切开术后肺部感染主要病原菌为G-杆菌，部分细菌的耐药率明显增加，应积极开展痰细菌培养及药敏试验,合理使用抗菌药物,以减少耐药菌株的产生。

Etiology and treatment of patients with lung infection after tracheotomy

Objective To study the etiological characteristic of patients with lung infection after tracheotomy. Methods The results of germiculture, the drug sensitivity from phlegm and the clinical data of 245 patients with lung infection after tracheotomy from January 2008 to December 2010 were reviewed. Results The incidence rate of iatrogenic infection of lung was 83.6%. 334 strains of pathogenic bacteria were isolated, of which 224 strains of Gram-negative bacilli accounted for 67.1%.The pathogens consisted of Pseudomonas aeruginosa (23.4%), Staphylococcus aureus(17.1%), Klebsiella pneumoniae(11.7%), Acinetobacter baumannii(10.5%), and Escherichia coli(9.6%). The drugs sensitive to Gram-negative bacilli were imipenem(73.7%) and piperacillin/tazobactam(61.1%), while the drugs sensitive to Gram positive cocci were vancomycin(100%) and nitrofurantion(92.9%). Drug resistance for ESBL(+)Gram negative bacilli and MRSA obviously increased(P＜0.05). Conclusions The main pathogen of lung infection after tracheotomy in the hospital is Gram-negative bacilli. Antibiotic resistance of bacteria becomes severe. Phlegm cultivation and drug sensitivity testing should be actively developed in the clinic.