目的 探讨ICU机械通气患者呼吸道感染革兰阴性杆菌的耐药情况及相关因素.方法选择ICU机械通气呼吸道感染革兰阴性杆菌患者98例,对痰液或下呼吸道分泌物标本中病原菌进行分类、鉴定及药敏试验,采用χ2检验分析与革兰阴性杆菌感染的相关因素.结果 经病原菌分类鉴定,革兰阴性杆菌占所有菌株的56.5%(432/764),排名前5位的革兰阴性杆菌分别为:铜绿假单胞菌(137株)、肺炎克雷伯菌(65株)、洋葱伯克霍尔德菌(52株),鲍氏不动杆菌(34株)、不动杆菌(28株);革兰阴性杆菌对头孢西丁耐药率最高,占93.7%,对头孢吡肟耐药率最低,占29.7%;经单因素χ2检验可见,患者年龄、基础疾病、住院时间、抗菌药物使用、侵入性操作、机械通气时间等因素与ICU机械通气患者呼吸道革兰阴性杆菌感染均相关(P<0.05或P<0.01).结论掌握ICU机械通气患者发生呼吸道感染的致病菌、耐药特点及相关因素,对其治疗方案的制订有较好的指导意义.%Objective To investigate the drug resistance rates and its correlative factors of Gram-negative bacilli in respiratory tract infection caused by ICU mechanical ventilation. Methods 98 cases of ICU patients with Gram-negative bacteria respiratory tract infection caused by mechanical ventilation were selected. Pathogen in the specimens of lower respirato -ry tract secretions or sputum was classified, identified and tested for drug susceptibility and the relevant factors of infection were analyzed. Results Among all classified and identified pathogens, 56.5% (432/764) were Gram-negative bacilli, the top 5 of which were pseudomonas aeruginosa strains (137 plants), klebsiella pneumoniae strains (65 plants), burkholderia hall german strains (52 plants), acinetobacter baumannii strains (34 plants) and acinetobacter strains (28 plants). Cefoxitin had the highest resistance rate of 93.7% and Cefepime had the lowest resistance rate of 29.7%. Univariate chi-square analysis revealed that age, basic disease, hospitalization time, antimicrobial drug use, invasive procedures and mechanical ventilation time were significantly related to Gram-negative bacteria respiratory infection caused by mechanical ventilation among ICU patients (P < 0.05 or P < 0.01). Conclusion Understanding the pathogens, drug resistance features and related factors of respiratory tract infection caused Ceftazidime by mechanical ventilation among ICU patients can help to improve the treatment plan.
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