ICU人工气道患者下呼吸道鲍氏不动杆菌感染及耐药性分析

Lower respiratory tract AB infection and drug resistancein ICU artificial airway patients

  • 摘要: 目的 分析ICU人工气道患者下呼吸道鲍氏不动杆菌感染及耐药性,为ICU人工气道患者的诊治提供依据。方法 选择2011年7月-2014年7月医院ICU 140例建立人工气道的患者为研究对象,对其下呼吸道感染病原菌进行鉴定,对鲍氏不动杆菌进行药敏试验。结果 ICU 140例患者发生鲍氏不动杆菌感染84例,感染率为60.0%;ICU 140例患者共分离出病原菌474株,其中革兰阳性球菌34株占7.2%,革兰阴性菌377株占79.5%,真菌63株占13.3%,其中革兰阴性菌中鲍氏不动杆菌检出率最高为35.4%;ICU患者发生鲍氏不动杆菌感染的影响因素有住院天数、癌症病史、建立人工气道前纤维支气管镜吸痰史和应用机械通气等;分离出鲍氏不动杆菌时间气管切开患者为(10.89±6.34)d,气管插管患者为(5.01±2.13)d,表明气管切开患者鲍氏不动杆菌的分离时间比较晚,差异有统计学意义(P<0.05);鲍氏不动杆菌对头孢类和喹诺酮类抗菌药物耐药严重,对阿米卡星的耐药率较低为39.9%,对多黏菌素、替加环素和米诺环素的耐药率低,分别为17.9%、10.7%和20.8%。结论 人工气道患者下呼吸道鲍氏不动杆菌感染率较高,影响鲍氏不动杆菌感染的因素有癌症病史、建立人工气道前纤维支气管镜吸痰、应用机械通气等,鲍氏不动杆菌对多黏菌素、替加环素和米诺环素的耐药率低。

     

    Abstract: OBJECTIVE To study Acinetobacter baumannii infection and drug resistance in artificial airway patients in ICU lower airways,so as to provide the basis for diagnosis and treatment of ICU patients with artificial airway.METHODS A total of 140 cases of artificial airway patients in ICU of the hospital from Jul.2011 to Jul.2014 were selected as research subjects.The respiratory pathogens were identified,and A.baumannii were given susceptibility test.RESULTS Totally 84 cases of patients occurred A.baumannii infection,with the infection rate of 60.0%.Totally 474 strains of pathogens were isolated in 140 cases of patients with artificial airway,including 34 strains of gram-positive bacteria(7.2%),377 strains of gram-negative bacteria(79.5%),and 63 strains of fungi(13.3%),and the A.baumannii had the highest detection rate of 35.4%.among them were 168 strains of A.baumanniiisolated.The hospitalization day,the cancer history,bronchoscopy suctioning history and mechanical ventilation before artificial airway construction were the influencing factors for A.baumanniiinfection.The isolation time of A.baumannii in patients with tracheotomy was(10.89±6.34)d,which was significantly later than(5.01±2.13)d of those with tracheal intubation(P<0.05).A.baumannii was serious resistant to cephalosporins and quinolones,the resistant rate to amikacin was 39.9%,and the resistant rates to polymyxin,tigecycline and minocycline were17.9%,10.7% and 20.8%,respectively.CONCLUSION The lower respiratory tract A.baumannii infection rate of artificial airway patients is relatively high.The influencing factors for A.baumannii infection are history of cancer,bronchoscopy suctioning history,mechanical ventilation,etc.A.baumannii have serious drug resistance to polymyxin,and low to tigecycline and minocycline.

     

/

返回文章
返回