气管切开烧伤患者痰液病原菌分布及其耐药性分析

目的 探讨我院近3年烧伤患者气管切开后痰液病原菌分布及其耐药性,为临床抗感染治疗提供参考依据.方法 对2010-10至2013-10烧伤科94例气管切开患者375份痰标本进行细菌培养,根据检验结果对普通细菌、真菌的分布情况及药物敏感状况进行统计,对其菌种分布特点及耐药性进行分析.结果 革兰阳性球菌141株占47.5％,革兰阴性杆菌132株占44.4％,真菌24株占8.1％.金黄色葡萄球菌检出率最高,共141株占51.6％,其次是铜绿假单胞菌,共76株占27.8％,醋酸不动杆菌共29株占10.6％.金黄色葡萄球菌、铜绿假单胞菌有逐年下降的趋势,醋酸不动杆菌有逐年上升的趋势.金黄色葡萄球菌只有万古霉素有较高的抗菌活性,耐药率为14.9％,铜绿假单胞菌对头孢类抗生素呈现出较高的耐药率（超过50％）.结论 我院烧伤科气管切开后患者下呼吸道感染的病原菌中,主要为金黄色葡萄球菌、铜绿假单胞菌、醋酸不动杆菌.病原菌具有较高的耐药率.

Analysis of pathogen distribution and drug-resistance in sputum specimens from burn patients after tracheotomy

Objective To make reasonable choices of the clinical antibiotics and provide reference for clinical anti-infection treatment according to the data of pathogen distribution and drug-resistance in sputum specimens of burn patients after tracheotomy in recent 3 years in this hospital. Methods Totally 375 pathogens were isolated from samples of sputum from 94 burn patients after tracheotomy,from October 2010 to October 2013 in Liaoning Provincal Corps Hospital of Chinese People＇ s Armed Polices. Distribution and susceptibility of bacteria and fungi were statistically analyzed, to set up a database, describing the distribution of the pathogens and the drug-resistance rate of different types of bacteria, and to investigate the change of drug-resistance of common pathogenic bacteria in the 3 years. Results In 297 strains of pathogens, 141 isolates were Gram-positive cocci, accounting for 47.5% ; 132 isolates were Gram-negative bacilli, accounting for 44.4% and 24 isolates were fungi, accounting for 8.1%. The detection rate of Staphylococcus au- reus （ SA, 141 strains, accounting for 51.6% ） was the highest, next was Pseudomonas aeruginosa （ PA, 76 strains, accounting for 27. 8 % ）, and 29 strains of Acinetobacter calcoacetius （AC） were isolated, accounting for 10.6%. The proportion of SA and PA decreased year by year,while the proportion of AC showed increasing trend year by year. Vancomycin was the only active antibiotics against SA, the drug resistance rate was 14.9% , and PA showed high drug-resistance against cephalosporin antibiotics （more than 50% ）. AC was highly resistant with the drug resistance rate over 80%. Conclusions The pathogens isolated from burn patients with lower respiratory tract infection in recent years in Liaoning Provincal Corps Hospital of Chinese People＇ s Armed Police are mainly SA, PA and AC. The problem of bacterial resistance is serious ,which shows a high drug-resistance rate.