呼吸机相关性肺炎细菌学耐药性调查

Ventilator-associated pneumonia in intensive-care unit

目的 为防治呼吸机相关性肺炎 (VAP)提供科学依据。方法 对VAP的病原菌及耐药性进行多中心、较大规模的调查研究 ,分析 15 4例VAP的临床资料及呼吸道分泌物细菌培养的结果。结果 VAP的发生率为 36 5 % ,老年患者占6 1% ,晚发性发病占 73 38% ;病原菌以G-菌为主 ,占菌株总数的 77 93% ;铜绿假单胞菌、鲍曼不动杆菌、黄杆菌、嗜麦芽寡养单胞菌、金黄色葡萄球菌是VAP的主要致病菌 ;大多数G-菌对常用的抗菌药物已表现出较高的耐药率。结论 对机械通气患者应进行全面预防、加强监护、严密动态检测病原菌、合理使用抗生素 ,才能有效控制VAP。

Objective To explore pathogens and drug resistance in ventilator-associated pneumonia (VAP), and to provide the corresponding clinical prevention strategies. Method We analyzed 154 VAP patients' clinical data, pathogens distribution and resistance rate of bacilli. Results The incidence of VAP was 36.5%, the aged accounted for 61%. Among all the pathogens caused VAP, 77.93% of sputum culture results were gram-negative bacilli, most of which were Pseudomonas aeruginosa, Acinetobacter baumanii, Chryseobacterium, Pseudomonas maltophilia and Staphylococcus aureus. Most of gram-negative bacilli showed high resistance rate to common used antibiotics. Conclusions Extensive and dynamic monitoring of VAP pathogens and rational use of antibiotics were advocated for controlling VAP effectively.