老年患者呼吸机相关性肺炎的临床与病原菌研究

Pathogenic Bacteria in Senile Patients with Ventilator-associated Pneumonia

目的探讨老年患者呼吸机相关性肺炎(VAP)的临床危险因素和感染病原菌耐药性,以制定预防与控制方案。方法对205例老年VAP患者进行了年龄、基础疾病、机械通气方法、抗菌药物使用情况、感染病原菌种类、耐药率的回顾性调查与统计分析。结果205例老年VAP患者均患有严重的基础疾病;分别进行过气管插管、气管切开或呼吸机治疗;使用过多种广谱抗菌药物;医院VAP感染病原菌主要有:铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌、大肠埃希菌、嗜麦芽寡养单胞菌等,以上感染病原菌均具有多药耐药性;其中,检出铜绿假单胞菌、鲍氏不动杆菌泛耐药株24株,占二者总株数的22.0%。结论防治老年患者发生VAP应采取综合性措施:加强消毒隔离制度,缩短机械通气时间,重视VAP患者的护理,根据病原学的检测合理使用抗菌药物。

OBJECTIVE To approach the clinical risk factors in senile patients with ventilator-associated pneumonia （VAP） and the drug-resistance of pathogenic bacteria to institute the plan of prevention and controlling. METHODS The age, underlying diseases, mechanical ventilation methods, use of antibiotics, pathogenic strains and drug-resistance rate of the 205 VAP patients were reviewed retrospectively and analyzed statistically. RESULTS All of them had severl underlying diseases and were taken the treatment of tracheal intubation or incision of trachea with ventilator. The multiple broad-spectrum antibiotics had been used. Pathogenic bacteria comprised mostly Pseudomonas aeruginosa , Acinetobacter baumannii , Nlebsiella pneumonia, Escherichia coli , Stenotroph- omonas maltophiliae, etc. The above pathogenic bacteria possessed multidrug resistance. Among P. aeruginosa and A. baumannii, 24 pan-resistant strains were detected, accounting for 22. 0% （24/109）. CONCLUSIONS Comprehensive measures should be adopted in prevention and treatment of VAP, which include strengthening sterilization and isolation system, shortening the time of mechanical ventilation, more attention of VAP patients care and rationally using antibiotics according to etiological detection.