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目的探讨急诊ICU呼吸机相关性肺炎的病原学特点。方法以2011年1月至2012年1月入住我院急诊ICU应用呼吸机人工辅助呼吸且被诊断为呼吸机相关性肺炎的23例患者为观察对象,使用一次性无菌吸痰管从患者气管插管内吸取痰液标本,送实验室培养后行菌种鉴定及药敏试验。结果共检出病原菌70株,其中革兰阴性菌48株(占68.6%),排名依次为鲍曼不动杆菌16株、铜绿假单胞菌14株、大肠埃希菌6株、嗜麦芽窄食单胞菌6株、肺炎克雷白菌3株、其他革兰阴性菌3株;革兰阳性菌17株(占24.3%),排名依次为金黄色葡萄球菌12株、溶血葡萄球菌2株、其他革兰阳性菌3株;真菌5株(占7.1%)。大多数革兰阴性菌对亚胺培南及美罗培南敏感,但嗜麦芽窄食单胞菌对亚胺培南及美罗培南完全耐药。结论急诊ICU呼吸机相关性肺炎的主要致病菌为革兰阴性菌,多数革兰阴性菌对亚胺培南及美罗培南敏感,临床上应依据药敏试验结果选择敏感抗生素治疗呼吸机相关性肺炎。
Objective To investigate the etiological characteristics of ventilator-associated pneumonia in emergency ICU. Methods From January 2011 to January 2012, 23 patients admitted to our hospital emergency ICU with ventilator artificial assisted breathing and diagnosed as ventilator-associated pneumonia were observed. The patient was treated with a disposable sterile suction tube from the trachea Intubation in sputum specimens taken to send laboratory culture line identification and drug sensitivity test. Results A total of 70 pathogenic bacteria were detected, of which 48 were Gram-negative bacteria (68.6%), followed by 16 strains of Acinetobacter baumannii, 14 strains of Pseudomonas aeruginosa, 6 strains of Escherichia coli, 6 strains of Escherichia coli, 3 strains of Klebsiella pneumoniae and 3 strains of other Gram-negative bacteria; 17 strains of Gram-positive bacteria (accounting for 24.3%), followed by 12 strains of Staphylococcus aureus and 2 strains of Staphylococcus haemolyticus , 3 other Gram-positive bacteria and 5 fungi (7.1%). Most Gram-negative bacteria are sensitive to imipenem and meropenem, but Stenotrophomonas maltophilia is fully resistant to imipenem and meropenem. Conclusions The main pathogens of acute lung injury in intensive care unit are acute gram-negative bacteria. Most gram-negative bacteria are sensitive to imipenem and meropenem. In the clinical practice, sensitive antibiotics should be selected according to drug susceptibility test results to treat ventilator-related pneumonia.