146例呼吸机相关性肺炎患者革兰阴性菌感染情况分析

发布时间：2018-06-30 08:37

本文选题：肠杆菌科 + 肺炎　；参考：《重庆医学》2017年03期

【摘要】：目的回顾性分析呼吸机相关肺炎中革兰阴性菌感染的情况及其处理策略,以期为预防和治疗呼吸机相关性肺炎(VAP)提供参考。方法对146例因呼吸、神经系统疾病,感染性疾病,创伤、手术、心肺复苏等病因进入ICU救治而发生革兰阴性菌VAP患者进行回顾性分析。经口(鼻)气管插管、气管切开导管抽取痰液进行细菌培养、分离和药物敏感性试验。结果 146例患者均行经口、鼻气管插管或气管切开行机械通气48h以上,平均6d。其中早发性VAP(机械通气小于或等于3d)34例,晚发性VAP(机械通气大于3d)112例。细菌培养结果显示,感染的细菌主要有鲍曼不动杆菌38株,不动杆菌其他属11株,铜绿假单胞菌26株,肺炎克雷伯菌21株,大肠杆菌17株,阴沟肠杆菌7株,阪崎肠杆菌4株,司徒普罗威登菌4株,嗜麦芽单胞菌4株,棒状杆菌3株,短黄杆菌3株,诺米勒诺菌2株,格利斯特2株,粪产碱菌1株,产气杆菌1株。药物敏感试验显示,革兰阴性菌对碳青霉烯类、第4代头孢菌素、哌拉西林/他唑巴坦、喹诺酮类、氨基糖苷类敏感,但喹诺酮类、氨基糖苷类敏感度小于20%。结论革兰阴性菌VAP是机械通气过程中常见而严重的并发症之一,其细菌耐药发生率越来越高。
[Abstract]:Objective to analyze retrospectively the infection of gram-negative bacteria in ventilator-associated pneumonia (VAP) and its management strategy in order to provide reference for the prevention and treatment of ventilator-associated pneumonia (VAP). Methods 146 patients with Gram-negative bacteria VAP caused by respiratory, nervous system diseases, infectious diseases, trauma, surgery and cardiopulmonary resuscitation were retrospectively analyzed. Sputum was extracted from oral (nasal) tracheal intubation and tracheotomy for bacterial culture, isolation and drug sensitivity test. Results 146 patients were treated with nasal tracheal intubation or tracheotomy for more than 48 hours with an average of 6 days. There were 34 cases of premature VAP (mechanical ventilation < or equal to 3 days) and 112 cases of late onset VAP (mechanical ventilation > 3 days). The results of bacterial culture showed that there were 38 strains of Acinetobacter baumannii, 11 strains of Acinetobacter other genera, 26 strains of Pseudomonas aeruginosa, 21 strains of Klebsiella pneumoniae, 17 strains of Escherichia coli, 7 strains of Enterobacter cloacae and 4 strains of Enterobacter sakazakii. There were 4 strains of Stubbs, 4 strains of maltophilia, 3 strains of Corynebacterium, 3 strains of Xanthobacterium brevis, 2 strains of Normie Renaud, 2 strains of Glist, 1 strain of Alcaligenes faecalis and 1 strain of Aerobacterium. The drug sensitivity test showed that Gram-negative bacteria were sensitive to carbapenes, cephalosporins, piperacillin / tazobactam, quinolones and aminoglycosides, but the sensitivity of quinolones and aminoglycosides was less than 20g. Conclusion Gram-negative bacteria VAP is one of the common and serious complications during mechanical ventilation, and the incidence of bacterial resistance is increasing.
【作者单位】：四川省内江市中医医院ICU;
【分类号】：R563.1

【相似文献】