重症医学科机械通气患者肺内感染病原菌分析  

Analysis of pulmonary infections in patients with mechanical ventilation in Intensive Care Unit

作　　者：汪海源[1] 李国福[1] 臧彬[1] 

机构地区：[1]中国医科大学附属盛京医院重症医学科,辽宁沈阳110004

出　　处：《中国现代医学杂志》2015年第24期38-41,共4页China Journal of Modern Medicine

摘　　要：目的 分析重症医学科（ICU）行机械通气患者肺内感染检出的病原菌及其时间分布特点,为临床抗生素的使用提供借鉴。方法 回顾性分析2012年1月-2013年3月,盛京医院ICU病房行机械通气患者痰细菌培养阳性的病原菌及其构成比以及该类患者入住ICU不同时间段（48 h内、3-7 d、8-14 d及14 d以后）细菌谱的构成情况。结果 行机械通气患者1 022例,其中痰细菌培养阳性病例为206例,肺内感染事件发生率20.16%。共分离病原菌株273株,其中革兰阴性杆菌、革兰阳性球菌和真菌分别为244株（89.38%）、28株（10.26%）和1株（0.37%）,占主导地位的病原菌分别为鲍曼不动杆菌（42.12%）、铜绿假单胞菌（18.68%）、肺炎克雷伯菌（16.12%）、金黄色葡萄球菌（9.16%）和大肠埃希菌（6.23%）。从分布时间上看,机械通气48 h之内检出率最高的病原菌为肺炎克雷伯菌（26.14%）,其次为鲍曼不动杆菌（25.00%）;机械通气48h之后检出率最高的病原菌分别为鲍曼不动杆菌（38.11%）和铜绿假单胞菌（15.16%）。不同时间段革兰阳性球菌以金黄色葡萄球菌为主。结论 ICU病房行机械通气患者48 h内、3-7 d、8-14 d及14 d后的肺内感染发生率分别为32.23%、30.40%、16.85%及20.51%。所有检出病原菌中89.38%为革兰阴性杆菌,以非发酵菌为主（主要为鲍曼不动杆菌和铜绿假单胞菌）,10.26%为革兰阳性球菌,以金黄色葡萄球菌为主。真菌检出率较低,仅占0.37%。【Objective】 To analyze pulmonary infections of patients hospitalized in the Intensive Care Unit（ICU） with mechanical ventilation, and to obtain bacterial spectrum characteristics and distribution in order to provide an offer to the clinical use of antibiotics. 【Methods】 Spectrum of bacterial culture of sputum and bacteria spectrum distribution of the patients with mechanical ventilation in different period（mechanical ventilation within the first 48 h, 3 -7 d, 8 -14 d and after 14 d） in our ICU from January 2012 to March 2013 were retrospectively analyzed. 【Results】 There were 206 positive cases in 1,022 mechanical ventilation cases,the pulmonary infections rate was 20.16%. A total of 273 pathogens were isolated, among which Gram-negative bacilli accounted for 89.38%, Gram-positive cocci accounted for 10.26% and fungus accounted for0.37%. Acinetobacter baumannii（42.12%）, Pseudomonas aeruginosa（18.68%）, Klebsiella pneumoniae（16.12%）,Staphylococcus aureus（9.16%） and E.coli（6.23%） were the predominant species. According to hospitalization time, Klebsiella pneumoniae（26.14%） and Baumannii（25.00%） were the main species within 48 h of mechanical ventilation. Acinetobacter baumannii（38.11%） and Pseudomonas aeruginosa（15.16%） were the predominant species after 48 h of mechanical ventilation. Staphylococcus aureus was the main species of Gram-positive cocci in different period. 【Conclusions】 The incidence of pulmonary infection with mechanical ventilation in different period（within the first 48 h, 3 -7 d, 7 -14 d and after 14 d） are 32.23%, 30.40%, 16.85% and20.51% in our ICU. Unfermenters are the predominant pathogens in Gram-negative bacilli which acount for89.38%. Staphylococcus aureus is more common in Gram-positive cocci which account for 10.26%. Fungi only account for 0.37%.

关 键 词：重症医学科 肺内感染 呼吸机相关性肺炎 细菌谱 

分 类 号：R446.19[医药卫生—诊断学]