呼吸监护室71例革兰阴性菌致下呼吸道感染病例临床分析

Seventy-one patients with Gram-negative bacteria lower respiratory tract infection

  • 摘要: 目的 探讨我院呼吸监护室革兰阴性菌致下呼吸道感染(LRTI)患者病例特点,分析革兰阴性菌致下呼吸道感染患者死亡危险因素;探讨其细菌分布与耐药性,为临床控制下呼吸道革兰阴性菌感染提供参考。 方法 回顾性调查我院呼吸科2009年1月-2010年3月71例革兰阴性菌致下呼吸道感染患者临床信息,对可能的死亡危险因素进行分析;调查下呼吸道标本所分离的革兰阴性菌分布,并对其进行药敏试验。 结果 APACHE-Ⅱ评分是革兰阴性菌致下呼吸道感染患者死亡的独立危险因素(P=0.00)。71例下呼吸道感染患者,分离出革兰阴性菌105株,以鲍曼不动杆菌、铜绿假单胞菌为主,分别占60.9%、27.7%。药敏结果显示鲍曼不动杆菌除对米诺环素耐药率81.3%以外,其余均达到95.5%以上;铜绿假单胞菌对多种抗菌药物耐药率均达到55.0%以上。 结论 APACHE-Ⅱ评分越高,革兰阴性菌致下呼吸道感染患者死亡率越高。我院呼吸科下呼吸道感染革兰阴性菌以鲍曼不动杆菌、铜绿假单胞菌为主,其对多种抗菌药物耐药,临床应加强病原菌耐药监测及抗菌药物的合理使用。

     

    Abstract: Objective To provide the reference for the clinical control of Gram-negative bacteria lower respiratory tract infection(LRTI) by studying the characteristics of patients with Gram-negative bacteria LRTI,the distribution and drug resistance of Gram-negative bacteria in Respiratory Intensive Care Unit of our hospital,and analyzing the risk factors for the mortality of LRTI patients. Methods Clinical data about Gram-negative bacteria LRTI patients admitted to Respiratory Intensive Care Unit of our hospital from January 2009 to March 2010 and the possible risk factors for mortality of LRTI patients were retrospectively analyzed.Distribution of the bacteria in lower respiratory tract was investigated,and drug sensitivity test was performed fro the bacteria. Results APACHE-Ⅱ score was the risk factor for mortality of Gram-negative bacteria LRTI patients.One hundred and five strains of Gram-negative bacteria were isolated from 71 LRTI patients,of which Acinetobacter baumannii and Paeudomonas aeruginosa accounted for 60.9% and 27.7% respectively.Drug sensitivity test showed that the resistance of Acinetobacter baumannii to minocycline and other antibiotics was 81.3% and over 95% respectively,while that of Paeudomonas aeruginosa to a variety of antibiotics was over 55%. Conclusion The higher the APACHE-Ⅱ score is,the higher the mortality of LRTI patients is.The main Gram-negative bacteria found in LRTI patients of our department are Acinetobacter baumannii and Paeudomonas aeruginosa,thus drug sensitivity test should be routinely performed and antibiotics should be rationally used in clinical practice.

     

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