重症监护病房肠球菌呼吸机相关性肺炎临床分析

Clinical analysis of ventilator-associated pneumonia caused by enterococci in intensive care unit

目的探讨肠球菌呼吸机相关性肺炎（ventilator-associated pneumonia，VAP）的临床相关因素及病原学特点，以指导临床防治。方法应用回顾性调查的方法对广州市第一人民医院2003年1月至2007年11月重症监护病房发生的41例肠球菌VAP进行临床病例分析。结果41例患者均有基础疾病，其中危重疾病如脑血管意外、良恶性肿瘤术后、慢性阻塞性肺疾病、重症肺炎、颅脑挫伤较常见；肠球菌感染中以粪肠球菌为多（63．6％），屎肠球菌为29．5％，肠球菌对临床常见抗生素如环丙氟哌酸、红霉素、青霉素、庆大霉素等耐药率较高，分别为77．3％、86．4％、51．3％、74．4％，其中屎肠球菌对氨苄青霉素和青霉素的耐药率明显高于粪肠球菌（P〈0．01，P=0．018），此次分离的肠球菌未发现耐万古霉素菌株，但检出万古霉素中介粪肠球菌3株（6．8％），所有肠球菌均对替考拉宁敏感；41例患者最后死亡21例，病死率达51．2％。结论肠球菌引起的VAP多发生于接受有创操作及有基础疾病患者，因其多重耐药，病死率高，需加强临床防治工作，以降低VAP的发病率和病死率。

Objective To investigate the clinical related factors and characteristics of pathogens of ventilator-associated pneumonia（VAP） caused by enterococci in intensive care unit（ICU） to determine the prevetion and treatment strategies. Methods A retrospective analysis was performed on 41 patients with VAP caused by enterococci in ICU from Jan. 2003 to Nov. 2007. Results The underlying diseases existed in all 41 cases, of which serious underlying diseases, such as cerebrovascular disorders,after operation of benign or malignant neoplasms, chronic obstructive pulmonary disease, severe pneumonia, brain injury were much common. Enterococcis of VAP in ICU mostly were Enterococci faecalis（63.6%）, Enterococci faecium was 29.5%. The resistance rate of enterococci to ciprofloxacin, erythromycin, penicillin and gentamicin was 77.3% ,86.4% ,51.3% and 74.4%, respectively. The resistance rate of Enterococci faecium was obviously higher than that of Enterococci faecalis to ampicillin and penicillin（ P 〈0.01, P =0. 018）. In this study,the enterococcis of vancomycin-resistance or teicoplanin-resistance were not found,but there were 3 vancomycin-intermediary Enterococci faecalises in 44 enterococcis （6.8%）. The mortality of the patients infected VAP caused by enterococci was 51.2% in ICU. Conclusions VAP caused by enterococci in ICU is very common in patients who have underlying diseases or receive invasive operation, the mortality is very high because of multidrug-resistance,so it is important to enhance the prevetion and treatment of this disease for decreasing its mortality and morbidity.