ICU获得性肺炎的病原菌分析及预防治疗对策

目的 探讨分析重症监护病房(ICU)医院获得性肺炎的发生原因、病原菌的分布和耐药性,并提出相应的预防治疗对策.方法 选择2008年2月-2010年2月在重症监护病房发生获得性肺炎的72例患者临床资料进行回顾性分析,从患者深部气道吸痰取样,用VITEK-2系统对标本进行分析鉴定和药敏试验.结果 痰培养结果显示,革兰阴性杆菌占多数,占88.89％,其中以铜绿假单胞菌、鲍氏不动杆菌与肺炎克雷伯菌3种细菌检出率高,分别占41.67％、18.06％、12.50％,而革兰阳性球菌仅占11.11％,主要以表皮葡萄球菌、金黄色葡萄球菌两种细菌为主,均占4.17％；药敏试验出现多药耐药现象；发病原因主要与原发病、意识障碍、气管切开或者气管插管以及机械通气有关.结论 合理应用抗菌药物、维持呼吸道通畅、全身支持治疗可以有效地预防治疗重症监护病房获得性肺炎.

Pathogens causing hospital-acquired pneumonia in ICU and countermeasures for prevention and treatment

OBJECTIVE To explore the causes for hospital-acquired pneumonia,distribution of the pathogens,and the drug resistance in intensive care unit(ICU) and to put forward the corresponding prevention and treatment countermeasures.METHODS The clinical data of 72 patients with hospital-acquired pneumonia who enrolled the ICU from Feb 2008 to Feb 2010 were analyzed retrospectively,the sputum was sampled from the deep airways,the statistical analysis of the specimen culture and the drug susceptibility testing were performed by VITEK2 system.RESULTS The sputum culture result indicated that the majority of the isolated bacteria were gram-negative bacilli,accounting for 88.89%,among which Pseudomonas aeruginosa(41.67%),Acinetobacter baumannii(18.06%) and Klebsiella pneumoniae(12.50%) were the top 3 identified species.The gram-positive cocci only accounted for 11.11%,among which the Staphylococcus epidermidis and S.aureus were the major species,both accounting for 4.17%;the drug susceptibility test showed that the isolates were multidrug-resistant;the etiology of the hospital-acquired pneumonia was related to the primary disease,disturbance of consciousness,tracheal intubation,tracheotomy,and mechanical ventilation.CONCLUSION It is necessary to use antibiotics reasonably,maintain smooth airway,and perform the systemic support therapy so as to effectively prevent and treat the hospital-acquired pneumonia in the ICU.