老年呼吸机相关性肺炎病原学及耐药性分析

Analysis of atiology and drug resistance of senile ventilator-associated pneumonia

目的:探讨重症监护病房(ICU)老年呼吸机相关性肺炎(ventilator asociated pneumonia,VAP)病原菌菌种分布及耐药谱,为临床合理使用抗菌药物提供依据。方法:对ICU近1年老年机械通气患者临床标本中分离的致病菌进行比较分析。结果:共检出致病菌69株,其中革兰阴性细菌58株(84.05%),真菌7株(10.14%),革兰阳性细菌4株(5.79%)。革兰阴性菌是VAP的主要致病菌,主要为假单胞菌属、肠杆菌属、克雷伯菌属。其中铜绿假单胞菌为第一位致病菌,药敏试验结果亚胺培南、阿米卡星总敏感性最高,其次为哌拉西林/他唑吧坦、头孢吡肟、头孢哌酮/舒巴坦、环丙沙星,对第二代头孢菌素、头孢噻肟、头孢曲松、头孢他啶则有较高的耐药性。结论:革兰阴性菌是VAP的主要致病菌,真菌感染不容忽视。病原菌呈现出多重耐药现象,在经验性抗感染治疗时应考虑对常见致病菌有较好覆盖率且耐药性低的抗生素,同时积极开展病原学检查,指导合理有效使用抗菌药物。

Objective ：To investigate the distribution and drug resistance spectrum of the pathogens of ventilator-associated pneumo- nia（VAP） in patients over 60 years old in intensive care unit（ICU）, so as to provide an evidence for reasonable application of antibiotics in clinic.Methods：The pathogen from ventilated patients over 60 years old in ICU in the last one year was isolated respectively,and their susceptibility to different antibiotics was analysed comparatively.Results：69 strains of pathogen were found out,including 58 strains （84.05%） as gram-negative bacterium,7 strains （10.14%） fungus and 4 strians （5.79%） gram-positive bacterium.The major pathogen of VAP was gram-negative bacterium,such as Pseudomonas,Enterobacter and Klebsiella,in which the primary pathogen was pseudomonas aeruginosa.The drug sensitivity test showed that the pseudomonas aeruginosa was most markedly susceptible to imipenem and amikacin, also susceptible to piperacillin/tazobactam, cefepime, cefoperazone/sulbactam and ciprofloxacin,however,highly drug resistant to cephalosperins of the second generation and some of those of the third generation e.g.cefotaxime, ceftriaxone and ceftazidime.Condusion： The major pathogen of VAP is gram-negative bacterium,fungus infection cannot be neglected.Given the possible multiple drug resistance of pathogen ,appropriate antibiotics with low drug resistance of potential should be empirically used against infection in ventilated patients over 60 years old in ICU.Pathogen test prior to or concurrent with ant-microbiological therapy is important in guiding the reasonable application of antibiotics.