ICU气管切开患者下呼吸道定植菌分析及防治对策

目的了解重症监护病房气管切开患者下呼吸道定植菌(lower airway bacterial colonization,LABC)的病原菌分布和耐药谱,为临床诊断LABC提供参考依据,防止定植菌转变为致病菌提供临床防治方法。方法入选2008年10月至2011年6月入住ICU气管切开患者下呼吸道进行支气管肺泡灌洗,并对灌洗液进行细菌定量培养及抗菌药物敏感性测定。结果 180例气管切开患者LABC检出率高达85.2%,培养出定植菌232株,以革兰阴性菌(G-)为主,占78.8%,其中铜绿假单胞菌62株,居首位占26.7%;肺炎克雷伯杆菌36株,居第2占15.5%;其次为鲍曼不动杆菌(占12.1%)、大肠埃希菌(占8.2%)、洋葱伯克霍尔德菌(占4.3%)和嗜麦牙寡养单胞菌(占3.4%)。革兰阳性菌(G+)占14.7%,主要为金黄色葡萄球菌;真菌占6.5%,主要为白色假丝酵母菌属。耐药监测结果显示,革兰阴性菌均出现较强的耐药性。结论加强对气管切开患者LABC的监测与控制,加强肺部综合护理才能防止定植菌转变为致病菌,减少再次感染的发生。

Lower airway bacterial colonization in ICU patients with tracheotomy:analysis and prevention strategy

Objective To investigate the etiological characteristics of lower airway bacterial colonization(LABC) in ICU patients with tracheotomy and improve the prevention and diagnosis of LABC.Method 180 admitted patients with tracheotomy in ICU were retrospectively analyzed.Lower respiratory tract of bronchoalveolar lavage was performed;lavage fluid was cultured and the antimicrobial susceptibility of the pathogens was detected.Result LABC detection rate was as high as 85.2% in 180 cases of patients with tracheotomy.A total of 232 colonization pathogen strains were isolated.Gram-negative bactilli(GNB) were the main pathogens in LABC,accounting for 78.8%,of which Pseudomonas aeruginosa was rated as the top one(26.7%),followed by Klebsiella pneumoniae(15.5%),Acinetobacter baumannii(12.1%),Escherichia coli(8.2%),Burkholderia cepacia(4.3%),and Stenotrophomonas maltophilia(3.4%).Gram-positive bacteria accounted for 14.7%,mainly Staphylococcus aureus;fungi accounted for 6.5%,mainly Candida albicans.Drug resistance surveillance showed that GNB has strong resistance.Conclusion The monitoring and controlling on LABC in patients with tracheotomy must be strengthened to improve clinical diagnoses,prevent the colonization inlungs from transfirming into bacterial pathogens,and reduce the incidence of re-infection.