呼吸机相关肺炎病原菌分布及耐药性分析

Distribution and Drug-resistance of Pathogens in Patients with Ventilator-associated Pneumonia

目的 研究呼吸机相关肺炎 (VAP)病原菌来源、分布特点及医院内产超广谱 β 内酰胺酶 (ESBLs)细菌的流行特征。方法 对机械通气患者下呼吸道分泌物进行细菌定量培养及抗菌药物敏感性测定 ;对产ESBLs细菌进行检测及质粒酶切图谱分析。结果 VAP病原菌以G-杆菌为主 ,检出产ESBLs细菌 9株 ,均不同程度表现为多重耐药 ;其中 5株来源于RICU产ESBLs肺炎克雷伯菌 ,经质粒酶切图谱分析证实为同一克隆起源。结论 VAP主要是由G-杆菌引起 ,耐药率普遍较高 。

OBJECTIVE To investigate the prevalence and the changes in drug resistance of pathogens in patients with ventilator associated pneumonia (VAP). METHODS The secretion of lower respiratory tract of patients received mechanical ventilation or tracheostomy for more than 48 hours was cultured with a quantitative method and their antibiotic susceptibility was detected with disk diffusion method. At the same time, plasmid mediated extended spectrum β lactamases (ESBLs) were measured by E test, and the epidemiology of ESBLs pathogens was investigated using plasmid restriction endonuclease fingerprinting. RESULTS The main pathogens in VAP were Gram negative bacilli(GNB). Nine of 36 GNB produced ESBLs, and exhibited a multidrug resistance.Plasmid restriction endonuclease analysis proved that plasmid fingerprintings of five Klebsiella pneumoniae strains producing ESBLS from RICU were the same type. CONCLUSIONS GNB are still the most important pathogens in VAP and have resistant to antibiotics. The transferable plasmids play a major role in the spread of the drug resistant bacteria.