Analysis Of Pathogen Distribution And Drug-resistance Of Sputum Specimens In Burn Patients After Tracheotomy

Inhalation injury may occur in burn patients with large area of skin,and airway obstruction caused by inhalation injury is one of the maincauses of death in the patients. In early state of burn patients, tracheotomy,an important measure, may give rise to improvement of airwayobstruction and hypoxia and reduce the mortality. However, lowerrespiratory tract infection and other complications caused by tracheotomynot only extend the patient’s hospital stay, and also increase the cost oftreatment. Therefore, identification of pathogens and antibioticsusceptibility tests should be carried in burn patients with lowerrespiratory tract infection after tracheotomy in burn unit. Early andrational use of antibiotics and improvement of lower respiratory tractinfections are medically significant of improving the quality of life inburn patients.In this study,375of burn patients after tracheotomy, from January2010to December2012in our hospital, were selected for bacterialcultivation and antibiotic susceptibility tests. Among375cases of sputumspecimens,297were positive (79.2%), including273strains of bacterialisolates (91.9%) and24strains of fungal isolates (8.1%).141isolates aregram-positive cocci (Staphylococcus aureus, predominantly),132isolatesare gram-negative bacilli (76stains of Pseudomonas aeruginosa,29strains of Acinetobacter calcoacetius,20strains of Klebsiellapneumoniae,4strains of Proteus mirabilis,1strain of Stenotrophomonas maltophilia,1strain of Pseudomonas maltophilia and1strain ofPseudomonas fluorescens). Fungal isolates include9strains of Candidaalbicans,6strains of Candida glabrata,4strains of Candida tropicalis,3strains of Candida krusei and2strains of yeast-like spores. Antibioticsensitivity test showed that most bacterial isolates exhibit resistant topenicillin, second and third-generation cephalosporins, macrolides andsulfonamides. Resistance rates to quinolones, aminoglycosides andtetracyclines are relatively higher. Four-generation cephalosporins,β-lactam enzyme inhibitor complex, carbapenems and glycopeptides havea relatively high antibacterial effect on these isolates. Moreover, burnpatients with fungal infection in lower respiratory tract should be given asufficient attention. In short, the ratio of gram-positive bacteria togram-negative bacteria is little difference (constituent ratio is47.5%and44.4%, respectively) in burn patients with lower respiratory tract infection.Most isolates exhibit resistant to antibiotics commonly used in clinicalpractice, and rates of most strains of isolates capable of developingantibiotic-resistance are on the increase year by year. Identification ofpathogens from sputum samples in burn patients after tracheotomy shouldbe carried out as soon as possible, a reasonable choice of antibiotics basedon drug-sensitivity test and improvement of patient’s immune defensefunction may slow down the formation of bacterial and fungalantibiotic-resistant infections.