住院重症患者气管切开后下呼吸道感染情况研究  

Prevalence of lower respiratory tract infections in critically ill hospitalized patients after tracheotomy

作　　者：冯兴林[1] 王舜尧[1] 黎萍[1] 

机构地区：[1]衢州市人民医院重症医学科,浙江衢州324000

出　　处：《中华医院感染学杂志》2018年第1期29-31,共3页Chinese Journal of Nosocomiology

摘　　要：目的探究住院重症患者气管切开后下呼吸道感染情况以及感染病原菌的分布,为临床预防控制医院感染提供参考。方法选取医院2014年1月-2016年12月期间行气管切开的102例住院重症患者作为研究对象,比较不同疾病患者下呼吸道感染率,对所有患者下呼吸道分泌物进行培养与鉴定。结果 102例气管切开住院重症患者中57例发生下呼吸道感染,感染率为55.9%;不同重症患者下呼吸道感染率比较发现,神经外科19例患者发生感染占33.3%,呼吸科24例患者发生感染占42.1%,其他科室共14例患者发生感染占24.6%;57例感染患者下呼吸道分泌物标本中共检测出84株病原菌,其中革兰阴性菌46株,占54.8%,革兰阳性菌31株,占36.9%,真菌7株,占8.3%,其中革兰阴性菌以大肠埃希菌、肺炎克雷伯菌及鲍氏不动杆菌为主,革兰阳性菌以金黄色葡萄球菌和表皮葡萄球菌为主。结论重症患者气管切开后易发生下呼吸道感染,病原菌以革兰阴性菌感染为主。OBJECTIVE To explore the prevalence of lower respiratory tract infections in critically ill hospitalized patients and observe the distribution of pathogens causing the infections so as to provide guidance for clinical pre- vention and control of the nosocomial infections. METHODS A total of 102 critically ill hospitalized patients who underwent tracheotomy from Jan 2014 to Dec 2016 were recruited as the study objects, the incidence of lower re- spiratory tract infections was compared among the patients with different diseases, the lower respiratory tract se- cretions that were obtained form all of the patients were cultured, the isolated pathogens were identified, and the distribution of pathogens was observed. RESULTS Of the 102 critically ill hospitalized patients who underwent tracheotomy, 57 had lower respiratory tract infections, with the infection rate 55.9 %, of whom 19 （33.3%） were in neurosurgery department, 24 （42.1%） were in respiratory medicine department, and 14 （24.6%） were in other departments.Totally 84 strains of pathogens were isolated from the lower respiratory tract secretions of the 57 pa- tients with infections, including 46 （54.8%） strains of gram-negative bacteria, 31 （36.9%） strains of gram-posi- tive bacteria and 7 （8.3%） strains of fungi~ Escherichia coli, Klebsiella pneumoniae and Acinetobacter bauman- nil were dominant among the gram-negative bacteria~ the Staphylococcus aureus and Staphylococcus epidermidis were the predominant species of gram-positive bacteria.CONCLUSION The critically ill patients tend to have lower respiratory tract infections after the tracheotomy, and the gram-negative bacteria are dominant among the patho- gens causing the infections.

关 键 词：住院重症患者 切开气管 下呼吸道感染 耐药性 

分 类 号：R563.1[医药卫生—呼吸系统]