VAP病原菌分布及耐药性的目标性监测研究

Targeted Surveillance of the Pathogen's Distribution and Drug Resistance in Patients with Ventilator-Associated Pneumonia

目的探讨机械通气患者呼吸机相关肺炎（VAP）及相关危险因素的微生物定植和常见耐药菌群的耐药情况。方法采用目标性监测方法，每隔24-48h采集机械通气患者下呼吸道、口咽部、胃液及呼吸机湿化器、冷凝器、螺纹管气管接口端前10cm内壁标本进行微生物培养、菌种鉴定和药敏试验。结果VAP的发病率为61．02％，且随着机械通气时间的延长发病率逐渐升高；本次研究共送检标本660份，分离菌株249株，下呼吸道、口咽部、胃液的主要定植菌为鲍曼不动杆菌、铜绿假单胞菌和粪肠球菌，对抗菌药物的平均耐药率为56．2％～72．5％；呼吸机装置的主要污染菌为铜绿假单胞菌、鲍曼不动杆菌属、肺炎克雷伯菌。结论VAP的致病菌以GNB为主，且为多重耐药菌。最初经验性抗菌治疗应依据病原学和耐药性监测结果。

Objective To study the pathogen colonization and drug susceptibility in patients with ventilator-associated pneumonia （VAP） and related risk factors. Methods With objective monitoring method, bacterial cultivation was performed in following places： patient＇s oropharynx, gastric juice, humidifiers, condenser, corrugated tube of ventilator, identification and drug susceptibility test were done at the same time. Results The incidence of VAP was 61.02%, and it increased while the time of mechanical ventilation was prolonged. 249 strains were isolated from 660 specimens. The main bacteria were Acinetobacter baumannii, Pseudomonas aeruginosa, Enterococcus faecalis in the lower respiratory tract, gastric juice, oropharynx. Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae were main bacteria at the tube of the ventilator. The average resistance rate to commonly used antibiotics was 56.2 % -72.5 %. Conclusions The most pathogens of VAP were Gram-negative bacillus and presented characters of multiple drug resistance to commonly used antibiotics. The use of antibiotics should be base on the results of bacterial cultivation and drug susceptibility test.