老年患者呼吸机相关性肺炎的病原菌及耐药性调查

Pathogens and Drug Resistance in Ventilator-associated Pneumonia in Elderly Patients

【目的】探讨老年患者呼吸机相关性肺炎(VAP)的病原菌及其耐药性,为临床诊断与治疗提供参考依据。【方法】对老年VAP患者年龄、性别、基础疾病进行病案调查;采用法国生物梅里埃VITEK32型微生物分析仪鉴定菌株并进行体外耐药监测。【结果】146例老年VAP患者均有严重的基础疾病;插管方式为经口气管插管、经鼻气管插管和气管切开等。VAP病原菌以G-菌为主(69.2%),其中肺炎克雷伯菌居首位(20.5%);铜绿假单胞菌次之(15.8%)。G+菌中甲氧西林耐药金黄色葡萄球菌(MRSA)占总株数的9.6%;甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS)占8.9%。体外耐药监测表明:5种居前列的G-菌均呈现较强的耐药性。【结论】应重视对老年VAP的病原学监测,以提高临床诊断与治疗水平。

[Objective] To explore pathogens and drug resistance in ventilator-associated pneumonia （VAP） ,and to provide reference for clinical diagnosis and treatment. [Methods]The ages,sex, underlying diseases were investigated;used VITEK32 of BioMérieux company to identificate bacteria and monitor antibiotic resistance in vitro. [Results]One hundred forty six elderly patients of VAP had serious underlying diseases. The way of tracheal intubation was through mouth, nose or incision of trachea. Gram-negative bacilli accounted for 69.2%,in which Kiebsiella pneumoniae rated the top one （50.0%） ,the next one was pseudomonas aeruginosa（ 15.8 %）. MRSA contributed 9.6% in Gram-negative bacilli, MRCNS contributed 8.9%. The result of the antibiotic resistance monitoring indicated that emergence of high resistance rate to commonly used antibiotics in the five most common Gram-negative bacili. [Conclusion]To improve the clinical diagnosis and treatment, the pathogen monitoring of VAP in elderly patients should be highly thought of .