医院内下呼吸道革兰阴性杆菌感染59例临床分析

目的：探讨医院内下呼吸道革兰阴性杆菌感染的病原菌谱、药物敏感性及主要危险因素。方法：回顾性分析我院1998年1月～2001年12月医院内获得性下呼吸道感染，所取痰标本行细菌学培养，阳性菌以K—B纸片法行药物敏感性测定。结果：共获73株革兰阴性杆菌，其中，铜绿假单胞菌(28．77％)，克雷伯杆菌(26．03％)，大肠埃希菌(23．28％)等，共同构成我院医院内下呼吸道感染的主要致病菌。基础疾病以气管插管或气管切开机械通气、昏迷、患有慢性阻塞性肺疾病、使用广谱抗生素以及高龄患者是造成医院内感染的主要危险因素。第三代头孢菌素、氟喹诺酮类和氨基甙类抗生素为治疗革兰阴性杆菌的有效抗生素。结论：抵抗力低下、不合理应用抗生素及基础疾病严重是造成医院内下呼吸道感染的主要危险因素。下呼吸道感染以革兰阴性杆菌感染为主。出现多重耐药菌，应根据药敏选择抗生素，必要时联合用药。

The hospital-acquired lower respiratory tract infections with Gram negative bacillus:A clinical analysis of 59 cases

Objective:To detect the cause of the bacterial spectrum,antibiotic susceptibility and the main risk factors for the hospital acquired lower respiratory tract infections with Gram negative bacillus of in patients in general wards.Methods:A retrospective analysis was made of the in patients suffering from hospital acquired lower respiratory infections between Jan.1998 and Dec.2001.Qualified sputum specimens were cultured for bacterial isolation,and the anti microbial activity tests were determined by K B methods.Results:Seventy three Gram bacillus were obtained.The three most common isolated bacteria were Pseudomonas aeruginosa (28.77%) , Klebsiella pneumoniae (26.03%) and E.coli (23.28%).The risk factors were closely associated with the duration of coma,length of tracheotomy and intratracheal intubations cannulation and use of broad spectrum antibiotics.Patients with chronic obstructive pulmonary disease(COPD) and the aged were more susceptible.The third generation of cefarosporins 4 quinolones and aminoglycosides were relatively active against the Gram negative bacillus.Conclusions:Low resistance,unreasonabee use of antibiotics and serious basic diseases are the most common risk factors associated with hospital acquired lower respiratory infections.Gram negative bacillus are the major pathogens causing lower respiratory infections with multidrug resistance.In clinical therapy,sensitive antibiotics should be selected based on drug sensitive tests and combined with other agents when necessary to accelerate the clearance of bacteria from respiratory tract infections.