呼吸机相关肺炎的病原菌临床分布及耐药监测

Microbiology of ventilator-associated pneumonia pathogens

目的探讨呼吸机相关性肺炎(VAP)的病原菌分布及其耐药性,为临床抗感染药物的正确应用提供参考。方法对呼吸科监护病房使用呼吸机的32例患者进行目标性监测,对病原学检查和细菌对抗生素耐药性结果进行回顾性分析。结果32例病人检出98株致病菌,其中革兰阴性菌占69.39%(68/98),革兰阳性菌占21.43%(21/98),真菌占9.18%(9/98);革兰阴性菌中铜绿假单胞菌(32.65%),肺炎克雷伯菌(16.33%),鲍曼不动杆菌(9.19%)为主要致病菌;革兰阳性菌中金黄色葡萄球菌(14.29%)占主导地位;念珠菌属仍为真菌感染的主要致病菌;致病菌对常用抗菌药的耐药性普遍升高。结论VAP的病原菌以革兰阴性菌占优势,铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌和鲍曼不动杆菌为RICU中VAP的主要致病菌,真菌感染的发生率不可忽视;致病菌耐药性升高,临床上应加强抗生素的合理使用。

Objective To examine the categories of ventilator- their drug- resistance so as to provide evidence for clinical rational use associated pneumonia （VAP） pathogens and of antibiotics. Methods 32 patients hospitalized in respiratory intensive care unit receiving ventilator respiration treatment were targetedly monitored. The microbial sensitivity tests and antibiotic test results were retrospectively analyzed. Results 98 pathogens were isolated from 32 patients, of which Gram - negative bacteria occupying 69.39% （68/69） of the isolates, Grampositive bacteria occupying 21.43% （21/98）, and fungi occupying 9.18% （9/98）. In Gram - negative bacteria isolates, Pseudomonas aeruginosa （32.65 % ） were the most commonly identified, followed by Klebsiella pneumoniae （16. 33% ） and Acinetobacter baumannii （9.19%） ; and in Gram - positive bacteria, Staphylococus aureus （14.29%） were the most commonly identified. Oidiomycetes tance of the pathogens were increasingly higher. were the major pathogens for fungi infections. The antibiotic resis- Conclusion In VAP pathogenic isolates, Gram- negative bacteria occupied the most. The most common VAP isolates in RICU were Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococus aureus and Acinetobacter baumannii, the incidence of fungi infection mignt not be ignored. The elevated elevatedantibiotic resistance of pathogens requied a rational clinical use of antibiotics.