胸外科患者术后肺不张合并肺部感染的病原学分析与抗菌药物治疗  

Etiological analysis of postoperative atelectasis complicated with pulmonary infections in thoracic surgery department patients and antibiotics therapy

作　　者：金冰[1] 刘华 胡述提[1] 樊新柯[3] 

机构地区：[1]南阳市中心医院胸外科,河南南阳473009 [2]武警8680部队医院急诊科,河南巩义451200 [3]南阳市中心医院小儿血液科,河南南阳473009

出　　处：《中华医院感染学杂志》2015年第17期3933-3934,3943,共3页Chinese Journal of Nosocomiology

基　　金：河南省卫生厅基金资助项目(HW-2012B025)

摘　　要：目的探讨胸外科患者术后肺不张合并肺部感染的病原菌分布及其耐药性,为临床治疗用药提供参考。方法选取胸外科术后肺不张肺部感染的患者204例,采集患者痰液标本进行细菌培养和药敏试验,对肺部感染的病原菌分布及其耐药性进行统计分析。结果 204例胸外科术后肺不张合并肺部感染患者共检出病原菌198株,其中革兰阴性菌119株占60.10%,革兰阳性菌77株占38.89%,真菌2株占1.01%;以大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌为代表的革兰阴性菌对氨苄西林和哌拉西林耐药率较高,均>66.00%,对亚胺培南的耐药率最低,<29.00%;以粪肠球菌、屎肠球菌及金黄色葡萄球菌为代表的革兰阳性菌对克林霉素、阿莫西林/克拉维酸、青霉素G及红霉素耐药率较高,均>61.00%,对万古霉素的耐药率为0,对替考拉宁的耐药率<4.00%。结论导致胸外科术后肺不张合并肺部感染的病原菌以革兰阴性菌为主,不同种类的病原菌对抗菌药物的耐药率存在较大差异,在感染早期可给予亚胺培南和万古霉素或者替考拉宁进行联合用药,以提高治疗效果。OBJECTIVE To explore the distribution and drug resistance of pathogens causing the postoperative atelectasis complicated with pulmonary infections in the thoracic surgery department patients so as to provide guidance for clinical use of antibiotics.METHODS A total of 204 patients with postoperative atelectasis complicated with pulmonary infections who were treated in the thoracic surgery department were enrolled in the study.The sputum specimens were collected for the bacterial culture,the drug susceptibility testing was performed,and the distribution and drug resistance of the pathogens causing the pulmonary infections were statistically analyzed.RESULTS Totally 198 strains of pathogens were isolated from the 204 patients with postoperative atelectasis complicated with pulmonary infections,including 119（60.10%）strains of gram-negative bacteria,77（38.89%）strains of gram-positive bacteria,and 2（1.01%）strains of fungi.Escherichia coli,Klebsiella pneumoniae,and Acinetobacter baumannii were dominant among the gram-negative bacteria and were highly resistant to ampicillin and piperacillin,with the drug resistance rates more than 66.00%,and the drug resistance rates to imipenem were less than 29.00%.Enterococcus faecalis,Enterococcus faecium,and Staphylococcus aureus were the predominant species of the gram-positive bacteria and were highly resistant to clindamycin,amoxacillin-clavulanic acid,penicillin G,and erythromycin,with the drug resistance rate more than 61.00%,the drug resistance rates to vancomycin were 0,and the drug resistance rates to teicoplanin were less than 4.00%.CONCLUSIONThe gram-negative bacteria are dominant among the pathogens causing the postoperative atelectasis complicated with pulmonary infections in the patients of the thoracic surgery department.The pathogens vary significantly in the drug resistance rates.The use of imipenem and vancomycin or teicoplanin for combination medication in early stage of the infections may improve the therapeutic effect.

关 键 词：胸外科 手术 肺不张 肺部感染 病原菌 抗菌药物 

分 类 号：R978.1[医药卫生—药品]