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目的:探讨慢性阻塞性肺病急性加重(AECOPD)合并Ⅱ型呼吸衰竭患者的气道分泌物中常见革兰阴性杆菌分布与耐药性。方法:回顾性分析2012-01-2013-09我院重症监护室接受机械通气治疗的AECOPD合并Ⅱ型呼吸衰竭患者气道分泌物中病原菌鉴定和药敏监测的结果。结果:69例患者共分离出病原菌104株,其中革兰阴性杆菌为主要致病菌,占78%。鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌为优势菌群,分别占41.9%、28.4%、12.4%。非发酵菌属细菌对常用抗菌药物的耐药较为普遍,肠杆菌属细菌也逐渐呈现耐药率增高的趋势。结论:AECOPD合并Ⅱ型呼吸衰竭患者的气道分泌物中的病原菌以革兰阴性杆菌的非发酵菌和肠杆菌科为主,在未取得药敏结果之前的初始治疗时采用针对性抗菌治疗较为合理。
Objective: To investigate the distribution and drug resistance of common Gram-negative bacilli in airway secretions of patients with acute obstructive pulmonary disease (AECOPD) and type Ⅱ respiratory failure. Methods: The retrospective analysis of the pathogen identification and drug susceptibility testing in airway secretions of patients with AECOPD Ⅱ respiratory failure who received mechanical ventilation in our intensive care unit from January 2012 to September 2013 was retrospectively analyzed. Results: A total of 104 pathogens were isolated from 69 patients, of which Gram-negative bacilli were the major pathogens, accounting for 78%. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae were dominant bacteria, accounting for 41.9%, 28.4% and 12.4% respectively. Non-fermentative bacteria commonly used antimicrobial resistance is more common, Enterobacteriaceae bacteria also gradually showed an upward trend in drug resistance. Conclusion: The pathogenic bacteria in airway secretions of AECOPD patients with type Ⅱ respiratory failure are mainly non-fermentative and Enterobacteriaceae of Gram-negative bacilli, and the targeted antibacterial treatment is more effective in the initial treatment before the drug-sensitive result is obtained reasonable.