建立人工气道时限与下呼吸道感染病原菌耐药的相关性分析

目的探讨重症监护病房人工气道患者下呼吸道病原菌感染及其相关因素。方法 2004年8月～2009年3月入住重症监护病房行气管插管或气管切开患者肺部感染病原菌进行培养、分离及药物敏感试验。结果 29例患者均合并下呼吸道感染,收集痰标本230份,检出病原菌78株,检出率为33.91%;其中革兰阴性菌49株,占62.82%,革兰阳性菌21株,占26.92%,真菌8株,占10.26%;感染居前4位的依次为嗜麦芽寡养单胞菌、大肠埃希菌、鲍氏不动杆菌、耐甲氧西林金黄色葡萄球菌,分别占24.36%、19.23%、15.38%、12.82%;建立人工气道第2周(81.39%)检出多药耐药菌高于第1周(68.57%),且前者革兰阴性菌对抗菌药物的敏感性低于后者。结论人工气道患者多药耐药菌感染率高,延长人工气道滞留时间增加多药耐药菌感染率。

Spectrum Distribution of Pathogens and Analysis of Associated Factors in Patient with Artificial Airway

OBJECTIVE To investigate spectrum distribution of pathogens in patient with artificial airway and analyze the associated factors.METHODS The clinical data of 29 patients with tracheal intubation or tracheotomy from Aug 2004 to Mar 2009 were analyzed retrospectively.RESULTS Twenty nine patients were diagnosed as pneumonia.A total 78 isolates of pathogens were collected from 230 sputum culture.Most of them were Gram negative bacilli and Grampositive cocci and fuggi.The top four pathogens were stenotrophomonas maltophilia,Escherichia coli,Acinenetobacter baumannii,meticillin-resistant Staphylococcus aureus(MRSA).More multiple drug resistant(MDR)pathogens were detected out in patients two weeks after intubation or tracheofomy than those after one week,and it was the same in sensitive rates to antibiotics of G~-bacilli.CONCLUSIONS Patients with artifiecial airways have high infection rate of MDR pathogens.Retention time of artificial airway can increase infection of MDR pathogens of lower respiratory tract.