重症监护室中肺部多菌株感染的特点及其预防  

Particularity and prevention of multi-bacterial lung infection in ICU

作　　者：胡祖鹏[1] 楼浩明[1] 曹同瓦[1] 

机构地区：[1]复旦大学附属华山医院重症医学科,上海200040

出　　处：《中国急救医学》2002年第7期388-389,共2页Chinese Journal of Critical Care Medicine

摘　　要：目的　通过对重症监护室危重病患者的多菌株感染的回顾性分析 ,找出这类感染的特点 ,并提出抗感染对策。方法　采集重症监护室 115例危重病患者的痰涂片、培养及药敏 ,含 2种或 2种以上菌株予以分析。结果　细菌发生率肺炎杆菌为 6 5 2 2 % (75 / 115 ) ,铜绿假单胞菌为 5 3 0 4 % (6 1/ 115 ) ;多菌株感染中肺炎杆菌最先发生率为 4 5 2 2 % (5 2 / 115 ) ,铜绿假单胞菌 2 2 6 1% (2 6 / 115 )。肺炎杆菌 10 0 %耐药者 3例 ,为 4 0 0 % (3/ 75 ) ;铜绿假单胞菌 10 0 %耐药者 12例 ,为 19 6 7% (12 /6 1) ,表明后者易出现耐药性。真菌感染 11例。结论　两种或两种以上病原菌感染称为多菌株感染。最先发生的病原菌以肺炎杆菌、铜绿假单胞菌多见。重症监护室中危重病患者早期有针对性地联合应用抗肺炎杆菌药物和抗铜绿假单胞菌药物 ,有利于这类患者的抗感染治疗 ,同时应避免盲目应用广谱高效抗生素。这样 ,可减少铜绿假单胞菌对抗生素的耐药性 ,同时也可降低真菌感染的发生率 。Objective To find the particularity of multi-bacterial lung infection in ICU through retrospective analysis,and find the principles of antibiotic Methods Collect sputum of 115 critical ill patients,smear,culture and drug sensitivity Analyze the results of two or more kinds of bacterial specimens Results The incidence rate of Klebsiella is 65 22%(75/115 ), Bacillus pyocyaneus is 53 04%(61/ 115) The first incidence rate in multi-bacterial infection is Klebsiella The rate is 45 22%(52/115),and Bacillus pyocyaneus is 22 61% (26/115) 100% drug resistance in Klebsiella are 3 cases,being 4 00%(3/75) Bacillus pyocyaneus are 12 cases,being 19 67%(12/61) It shows Bacillus pyocyaneus is easy to be drug resistance Fungi infection are 11 cases Conclusions Two or more than two kinds of pathogen infection is called multi-infection The first ones are Klebsiella and Bacillus pyocyaneus Early to aim directly at these bacteria and associately use antibiotic drugs is benefit to these patients We should avoid blind using broad spectrum high effect antibiotic drugs Thus,the drug resistance of Bacillus pyocyaneus can be low,and the incidence rate of fungi infection also can be low Then we can raise the success rate of treatment

关 键 词：预防 重症监护室 危重病 多菌株感染 肺炎杆菌 铜绿假单胞菌 真菌 

分 类 号：R459.7[医药卫生—急诊医学]