急诊ICU呼吸衰竭并肺部感染患者的病原学及耐药性分析

目的探讨急诊重症医学科呼吸衰竭伴肺部感染患者病原菌类型和致病菌耐药性。方法选择2015年1月至2019年12月在本院急诊重症医学科治疗的187例呼吸衰竭伴肺部感染患者为研究对象。采集全部患者痰液标本进行细菌培养,并实施药物敏感试验,观察呼吸衰竭伴肺部感染患者病原菌类型及致病菌耐药性情况。结果187例患者经病菌培养及分离后共获取220株病原菌,其中革兰阳性球菌共有50株(22.73%),革兰阴性杆菌共有170株(77.27%)。在革兰阳性球菌中占比最高的三项依次是溶血葡萄球菌(8.64%)、凝固酶阴性葡萄球菌(5.45%)、金黄色葡萄球菌(4.55%)。在革兰阴性杆菌中占比最高的三项依次是铜绿假单胞菌(23.64%)、肺炎克雷伯菌(20.45%)以及鲍氏不动杆菌(18.64%)。临床呼吸衰竭伴肺部感染革兰阴性菌中铜绿假单胞菌、肺炎克雷伯菌以及鲍氏不动杆菌耐药性较高,其中肺炎克雷伯菌耐药性最显著;革兰阳性菌中溶血葡萄球菌、凝固酶阴性葡萄球菌以及金黄色葡萄球菌耐药性最高,其中金黄色葡萄球菌耐药性最显著。结论急诊重症医学科呼吸衰竭伴肺部感染患者主要致病菌为革兰阴性杆菌,并对临床常用抗菌药物均存在一定耐药性,其中肺炎克雷伯菌耐药性最高。因此对急诊重症医学科呼吸衰竭伴肺部感染患者进行抗菌药物治疗时,需掌握致病菌类型及药物敏感试验结果,合理选择抗菌药物,提升治疗效果。

Analysis on the etiology and drug resistance of patients with respiratory failure complicated with pulmonary infection in emergency intensive care unit

Objective To investigate the types of pathogens and drug resistance of pathogenic bacteria in patients with respiratory failure complicated with pulmonary infection in emergency intensive care unit (EICU).Methods A total of 187 patients with respiratory failure complicated with pulmonary infection admitted to EICU of our hospital from January 2015 to December 2019 were selected.Sputum samples were collected from all patients for bacterial culture and drug sensitivity test was carried out to observe the types of pathogens and drug resistance of pathogenic bacteria in patients with respiratory failure complicated with pulmonary infection.Results A total of 220 strains of pathogenic bacteria were obtained from 187 patients after bacterial culture and isolation,of which 50 strains were Gram-positive cocci(22.73%)and 170 strains were Gram-negative bacilli(77.27%).The highest proportion of Gram-positive cocci was staphylococcus haemolyticus (8.64%),coagulase-negative staphylococcus (5.45%) and Staphylococcus aureus (4.55%).Among Gram-negative bacilli,the highest proportion of Gram-negative bacilli was pseudomonas aeruginosa (23.64%),Klebsiella pneumoniae (20.45%) and acinetobacter Baumannii (18.64%).Among clinical respiratory failure with pulmonary infection,the drug resistances of pseudomonas aeruginosa,Klebsiella pneumoniae and acinetobacter Baumannii were higher,and Klebsiella pneumoniae was the most significant in drug resistance.Among Gram positive bacteria,Staphylococcus haemolyticus,coagulase negative Staphylococcus and Staphylococcus aureus had the highest drug resistance,among which Staphylococcus aureus was the most significant.Conclusion Gram-negative bacilli are the main pathogenic bacteria in patients with respiratory failure complicated with pulmonary infection in the EICU,and they all have certain drug resistance to commonly used clinical antibiotics,among which Klebsiella pneumoniae has the highest drug resistance.Therefore,it is necessary to master the types of pathogenic bacteria and the results of drug sensitivity test,and to choose antibiotics reasonably to improve the treatment efficacy when treating patients with respiratory failure complicated with pulmonary infection in EICU.