ICU气管切开患者医院感染分析

①目的 了解引起ICU气管切开患下呼吸道医院感染的主要病原菌种类及药敏性。②方法 无菌条件下取1998年1月－2000年12月ICU气管切开患的深部痰做培养及药敏试验，进行细菌学分析。③结果 143例气管切开患中，133例诊断为下呼吸道医院感染（93．0％）。送痰培养767次，培养出1153株病原菌，G^-杆菌821株（72．2％），其中绿脓杆菌196株（17％），G^ 球菌167株（14．5％），其中金黄色葡萄球菌103株（8．9％），真菌165株（14．3％）；混合感染340次，气管切开保留时间越长，混合感染率越高（P＜0．01）。氟康唑是首选的抗真菌药物，G^-杆菌对头孢类及青霉素类抗生素普遍产生耐药，G^ 球菌对万古霉素敏感（目前尚未发现耐药菌株），各类细菌对喹诺酮类及氨基糖甙类抗生素亦有一定程度的耐药性。④结论 气管切开后呼吸道防御病原菌免疫力下降，反复医源性交叉感染，大量广谱抗生素的广泛不合理应用是引起气管切开患易发下呼吸道医院感染的主要原因。

Nosocomial infection analysis of patients with tracheotomy in ICU

Objective To study the main bacilli and their antibiotic susceptibility which cause nosocomial lower respiratory tract infection in patients with tracheotomy in ICU.Methods The germ clutures of sputum obtained from lower respiratory tract were conducted and drug-susceptibility was tested.Results In all of the 143 cases,133 patients were diagnosised nosocomial lower respiratory tract infection(93%).1153 germ strains were separated from 767 sputum clutures and 821 strains were G - bacilli(71.2%),167 were G + cocci(14.5%),165 were fungi(14.3%).There were 340 mixed infections.The longer tracheotomy keeped,the more probabily mixed infection happened(P<0.01).Fluconazole is the first-choosen anti-fungi drug.G -baccili became resistant to cephalosporins and penicillin commonly,G + cocci still kept the susceptibility to vancomycin.There were also some aminoglycoside-and quinoxaline-antibiotic resistant bacteria.Conclusion Nosocomial lower respiratory tract infection occured easily in pateints with tracheotomy,because the defensive power of respiratory tract to germs decreased,nosocomial cross infection happened repeatedly and antibiotic used unreasonably.