Analysis Of The Pathogens Distribution And Drug Resistance Situation Of Patients With Mechanical Ventilation Associated Lower Respiratory Tract Infection In ICU

[Objective]To study the pathogens distribution and drug resistance situation of patients with mechanical ventilation associated lower respiratory tract infection in ICU during 2012 to 2014, provide an important reference for initial empirical anti infective therapy.[Methods]This research collects 350 ICU patients with mechanical ventilation who were diagnosed as lower respiratory tract infection in our hospital during January 2012 to December 2014, takes the pathogen isolation of sputum samples, and analysises the distribution, composition ratio and sensitive test. The categorical data were analyzed adopting Excel software and the relative numbers were expressed with rate and percentage.[Results]During January 2012 to December 2014,this research collects 500 qualified sputum specimens from 350 ICU patients with mechanical ventilation who were diagnosed as lower respiratory tract infection in our hospital. There were isolated pathogens from 396 in those specimenthe, the positive rate was 79.2%(396/500). A total of 528 strains of pathogenic include 432 strains (81.82%) of bacteria and 96 strains (18.18%) of Fungi.A total of bacteria include 356 strains 67.42% (356/528) of gram-negative bacterium,76 strains 14.39% (76/528) of gram-positive bacteria. Gram-negative bacterium mainly included 110 strains of Baumanii (30.90%),82 strains of Pseudomonas aeruginosa (23.03%),73 strains of Klebsiella pneumoniae (20.51%),45 strains of Escherichia coli(12.64%).To Baumanii,the drug sensitive rate of Polymyxin was 100%,and the drug sensitive rate of Tigecycline and Amikacin was more than 70% ,and the drug resistance rate of Cefazolin, Cefotetan and Nitrofurantoin was 100%. To pseudomonas aeruginosa,the drug sensitive rate of Polymyxin was 100%,and the drug sensitive rate of Amikacin, Ciprofloxacin, Levofloxacin,Tobramycin, Gentamicin, Piperacillin/tazobactam was 70-85%, and the drug resistance rate of Ampicillin, Ampicillin/sulbactam, Amoxicillin/ clavulanic acid, Cefazolin, Cefotetan and Nitrofurantoin was 100%. To klebsiella pneumoniae,the drug sensitive rate of Tigecycline, Imipenem, Amikacin, Meropenem, Ertapenem was 100%, and the drug sensitive rate of Cefotetan was 95.5%, the drug sensitive rate of Piperacillin/tazobactam was 83.3%, and the drug resistance rate of Ampicillin was 100%. To Escherichia coli,the drug sensitive rate of Tigecycline, Imipenem, Meropenem, Ertapenem was 100%, and the drug sensitive rate of Cefotetan, Amikacin, Piperacillin/tazobactam was more than 80%.Gram-positive bacterium mainly included Staphylococcus aureus.To Staphylococcus aureus, the drug sensitive rate of Tigecycline, Teicoplanin, Linezolid and Vancomycin, Quinupristin/Dafoe Putin was 100%,and the drug sensitive rate of Nitrofurantoin was 96.0%, and the drug sensitive rate of SMZ-TMP was 84.0%, and the drug sensitive rate of other commonly used antibiotics was lower than 70%.The most common fungus was Candida albicans.To Common fungi, the drug sensitive rate of Amphotericin B was 100%,and the drug sensitive rate of Voriconazole,Fluconazole,5-Fluorocytosine was more higher.Multi drug resistant bacteria isolation rate is relatively high, followed rankings for Kpn-ESBLs, Extensively Drug Resistant A.baumannii, methicillin resistant Staphylococcus aureu, Eco-ESBLs, resistant to methicillin resistant coagulase negative Staphylococcus. Vancomycin resistant Staphylococcus aureus has been not found during 3 years.Analyze the different characteristics in different clinical condition found that: Gram-negative bacteria had higher and higher incidence rate with the time prolong of mechanical ventilation. Gram-positive bacteria has lower incidence rate in nasal intubation patients, and had lower and lower incidence rate with the time prolong of mechanical ventilation, and fungal infection had higher incidence rate in COPD、 nasal intubation and bad prognosis patients.[Conclusion]In ICU patients with mechanical ventilation prone to secondary lower respiratory tract infection, gram-negative bacteria is the main infection pathogens. Drug sensitive test results showed that both the gram negative bacteria and gram positive bacteria, drug resistance is more serious, and even the emergence of multi drug resistant strains, pan drug resistant strains. Gram-negative bacteria had higher and higher incidence rate with the time prolong of mechanical ventilation. Gram-positive bacteria has lower incidence rate in nasal intubation patients,and had lower and lower incidence rate with the time prolong of mechanical ventilation,and fungal infection had higher incidence rate in COPD, nasal intubation and bad prognosis patients. Before Pathogenic results of the disease is not clear, the above results can provide a reference for clinicians to set on empirical anti infective treatment.