呼吸机相关性肺炎的临床分析与病原菌特点

The analysis of clinical and pathogenic bacteria characteristic in ventilator-associated-pneumonia(VAP)

目的了解2004年5月-2008年10月我院呼吸内科ICU病房呼吸机相关性肺炎（VAP）临床特点、病原菌分布和耐药的情况,为尽量避免VAP的发生及指导抗菌药物的正确应用提供参考资料。方法对79例VAP患者临床特点、痰病原学培养及药敏结果进行回顾性分析。结果 79例VAP患者共分离菌株132株,革兰阴性杆菌占49.2%,其中铜绿假单胞菌、肺炎克雷伯菌、肠杆菌科、嗜麦芽假单胞菌和鲍曼不动杆菌为主要致病菌;革兰阳性球菌占28.8%,耐甲氧西林金黄色葡萄球菌（MRSA）为主要致病菌;真菌感染的比例为22%。肺炎克雷伯菌和铜绿假单胞菌的耐药率很高,临床常用抗菌药物敏感率均不理想。结论革兰阴性杆菌仍然是VAP的主要致病菌,金黄色葡萄球菌、白色念珠菌亦为VAP的常见致病菌,均表现出较高的耐药性。

Objective To analyze the clinical characteristic and the distribution and drug-resistancc of pathogenic bacteria in ventilator-associated-pneumonia（VAP）occurring in respiratory ICU from May 2004 to October 2008 and provide a strategy of using antibacterial agents properly in order to decrease the incidence of VAP.Methods 79 patients with VAP were retrospectively analyzed in clinical feature、bacterial culture of sputum and result of medicine sensitiveness test.Results 132 bacterial strain were separated from the 79 patients among which the proportion of Gram-negative bacilli was 49.2%.The major pathogenic bacteiums are Pseudomonas aeruginosa、Klehsiella pneumoniae、Enterobatcter、Pseudomonas maltophilia、Acinetobacter baumannii.The proportion of Gram-positive cocci was 28.8%,among which methicillin-resistant.Staphy lococcus aureus（MRSA）was the major pathogenic bacteium.The proportion of mycotic infection was 22%.The durg resistence rate of Klebsiella pneumoniae and Pseudomonas aeruginosa was high,the sensitivity of common antibacterial agents was not ideal.Conclusion Gram-negative bacilli is still the major pathogenic bacteium of VAP.Staphy lococcus aureus and Monilia albican are also the common pathogenic bacteiums in VAP.They all show high durg resistence rate in clinical treatment.