重症监护病房呼吸机相关性肺炎病原菌及其耐药性变迁

Ventilator Associated Pneumonia Pathogenic Bacterium and its Drug Resistance Diversity in Intensive Care Unit

目的了解重症监护病房(ICU)呼吸机相关性肺炎(VAP)病原菌的分布和耐药性的变迁。方法对132例次VAP,按发生时间分为A、B两组,分别做痰培养及药物敏感试验,并对结果进行分析。结果A组64例次共检出致病菌92株,其中革兰阴性杆菌(GNB)61株(占66.3%),革兰阳性球菌(GPB)18株(占19.0%),真菌13株(占14.1%),B组68例次共检出致病菌95株,其中GNB58株(占61.1%),GPB22株(占23.2%),真菌15株(占15.8%)。药敏试验显示:A组13株葡萄球菌中甲氧西林敏感表皮葡萄球菌(MSSE)5株(占62.5%)、耐甲氧西林表皮葡萄球菌(MRSE)3株(占37.5%)、甲氧西林敏感金黄色葡萄球菌(MSSA)2株(占40%)、耐甲氧西林金黄色葡萄球菌(MRSA)3株(占60%)。B组18株葡萄球菌中MSSE3株(占30%)、MRSE7株(占70%)、MRSA8株(占100%)。葡萄球菌和肠球菌对万古霉素均100%敏感,对其余抗菌药物有不同程度耐药,GNB对常用抗菌药物的耐药率随时间而有不同程度的增加。结论VAP以GNB为主要致病菌,随着时间的推移,GPB感染的比例有所增加,耐多重药物的GNB、GPB感染率在增加,但尚无出现耐万古霉素的葡萄球菌和肠球菌。因此,合理使用抗菌药物尤为重要。

Objective To investigate the distribution of Ventilator Associated Pneumonia Pathogenic bacterium and diversity of its drug resistance. Methods The study was conducted in 132 VAP patients who were randomized into two groups （ group A, group B） by the sequence they join the study, sputum culture and drug sensitivity test were carried out separately in these two groups. Result 64 strains of bacterium were isolated in total 64 patients in Group A, among which gram negative bacillus constituted the proportion of 66.3% （61 strains） , gram positive bacillus 19.0% （18 strains） and fungus 15.8% （15 strains）. The susceptibility test demonstrated that 5 MSSE （62.5%） isolates and 3 MRSE （37.5%） isolates were detected in 13 staphylococci strains in Group A, while MSSA and MRSA isolates in the corresponding strains were 2 （40%） and 3 （60%） respectively. In Group B, 3 MMSE isolates （30%） , 7 MRSE isolates （70%） and 8 MRSA isolates （100%） were recorded. One hundred percent staphylococci and enterococci strains were sensitive to vancomycin, nevertheless resistant to other antibiotics variantly. As far as GNB was concerned, its drug tolarence to antibiotics was increased continually. Conclusion GNB infection is predominant in vAP. As the time goes, GPB infection is increased, multi - drug resistant GNB and GPB are isolated, yet vancomycin - resistant staphylococci and enterococci are not found. In all, it is of great importance to pay a close attention to rational administration of antibiotics.