老年患者呼吸机相关性肺炎病原菌及其耐药性分析

Distribution and drug-resistance of pathogens in elderly patients with ventilator-associated pneumonia

目的分析老年患者呼吸机相关性肺炎(VAP)病原菌的分布特点及其耐药状况,为VAP治疗提供有效、合理的用药参考。方法回顾性分析老年VAP 160例的下呼吸道分泌物细菌培养及药敏试验结果,统计VAP病原菌分布、构成以及革兰阴性菌耐药率情况。老年VAP根据中华医学会呼吸病学分会制定的《医院获得性肺炎诊断和治疗指南》确诊。结果本组160例下呼吸道分泌物培养出病原菌共284株,其中革兰阴性杆菌占74.3%,革兰阳性球菌占16.2%,真菌感染占9.5%;各类病原菌混合感染占80.4%。常见病原菌依次为耐甲氧西林金黄色葡萄球菌(MRSA)(85.3%),鲍曼不动杆菌(23.2%),铜绿假单胞菌(19.4%),肺炎克雷伯菌(18.3%),金黄色葡萄球菌(10.9%),白色念珠菌7.7%。鲍曼不动杆菌对头孢哌酮/舒巴坦较敏感;铜绿假单胞菌对头孢哌酮/舒巴坦和碳青酶烯类药物较敏感;肺炎克雷伯菌和大肠埃希菌对碳青酶烯类药物较敏感;金黄色葡萄球菌耐药现象严重,对万古霉素和替考拉宁较敏感;白色念珠菌对氟康唑、伊曲康唑、伏立康唑较敏感。结论老年患者VAP的主要病原菌以革兰阴性杆菌为主,耐药现象严重,多为混合感染,治疗困难;进行细菌培养和药敏试验对合理选用抗菌药物具有重要意义。

Objective To determine the distribution and drug resistance characteristic of pathogens in elderly patients with ventilator-associated pneumonia (VAP) and guide physicians to select antibiotics correctly. Methods The secretion of lower respiratory tract of 160 patients received tracheostomy and mechanical ventilation for more than 48 hours were cultured with a quantitative method and their antibiotic susceptibility was detected. The distribution and constitution of VAP pathogens and Gram-negative bacteria resistance rate were analyzed statistically. The diagnosis of VAP was made according to the Guidelines for the Diagnosis and Treatment of Hospital-acquired Pneumonia, which was made by the Respiratory Disease Branch of the Chinese Medical Society. Results Gram-negative bacilli (GNB) were the main pathogens in VAP. Among 284 strains of pathogens collected, the GNB accounted for 74.3%, the Gram-positive bacteria (GPB) were 16.2%, and the fungi were 9.5%. The mixed infections were present in 80.4%. Acinetobacter baumanniii was sensitive to cefoperazone/sulbactam; Pseudomonas aeruginosa was susceptible to imipenem/cilastatin; Klebsiella was susceptible to imipenem/cilastatin; Staphylococcus aureus was still highly susceptible to vancomycin. Conclusion GNB are still the most important pathogens in VAP and have multiple drug-resistance. Mixed infections are severe, bacterial culture and antibiotic susceptibility tests are very important to select antibiotics correctly for treatment of VAP.