重症监护病房中呼吸机相关性肺炎病原菌分布及耐药性分析

Analysis of pathogens distribution and antibiotic resistance for ventilator-associated pneumonia in ICU

[目的 ]呼吸机相关性肺炎 (VAP)是重症监护病房 (ICU )中最常见的院内感染 ,近几年由多重耐药菌引起的VAP逐渐增加。探讨VAP的病原菌分布及耐药性 ,为治疗VAP提供科学依据。[方法 ]回顾性分析 2 0 0 2年 7月～ 2 0 0 3年 12月中心ICU科收治的 97例有创机械通气超过 4 8h患者的临床资料 ,对 39例VAP患者的微生物学资料进行调查分析 ,用无菌吸痰管或经纤维支气管镜从下呼吸道采集分泌物进行细菌培养并做耐药试验。 [结果 ]VAP的发生率为 4 0 .2 %,病死率为6 1.5 %。共分离出病原菌 2 11株 ,其中革兰阴性菌占 80 .1%,铜绿假单胞菌居首位 ;革兰阳性球菌占 9.5 %;真菌占 10 .4 %;产超广谱 β内酰胺酶菌集中于产气肠杆菌、肺炎克雷伯杆菌、阴沟肠杆菌、大肠埃希菌 ,革兰阴性杆菌对常用抗菌药物表现出较高的耐药率。 [结论 ]中心ICU科中VAP病原菌以革兰阴性杆菌为主 ,并有多重耐药 ;严密动态监测病原菌及耐药性以达到有效控制VAP的目的。

ObjectiveVentilator-associated pneumonia(VAP) is the leading ICU infection, the frequency of VAP caused by multiantibiotic-resistant pathogens has increased in recent years. Pathogens distribution and antibiotic resistance in VAP were explored to provide the corresponding clinical treatment strategies. [Methods]The clinical data of all the 97 mechanical ventilation(>48 h) patients admitted to our comprehensive ICU from July 2002 to december 2003 were retrospectively investigated, The micro-organism data of all the 39 VAP patients were analysed. Aspsis tube or bronchofibroscope was used to obtain secretions from lower respiratory tract, The specimens were cultivated and examed drug-resistance . [Results] The morbidity of VAP was 40.2% and the mortality was 61.5%, A total of 211 pathogens were identified. Among all the strains causing VAP, Gram-negative bacteria accounted for 80.1%, in which Pseudomonas aeruginosa was the major pathogen. Gram positive cocci occuping 9.5% and 10.4% were fungi. Extened-spectrum β-lactamases-producing strains were identified in Enterobacter aerogen, Klebsiella pneumoniae, Enterobacter cloacae and Escherichia coli. All these indicated high resistant rate to commonly used antibiotics in Gram-negative bacteria. [Conclusion] Gram-negative bacteria were the most common pathogens of VAP in central ICU , which presented to multi-drug resistant pattern. To effectively control VAP, extensive and dynamical monitoring of VAP pathogens and Antibiotic resistance were advocated.