急诊重症监护病房呼吸机相关性肺炎患者的致病菌分布及耐药分析

Pathogens and drug-resistance of ventilator-associated pneumonia patients in emergency intensive care unit

目的观察急诊重症监护病房（EICU）机械通气患者呼吸机相关性肺炎的致病菌及耐药情况，为临床治疗提供依据。方法收集2007—2009年EICU发生呼吸机相关性肺炎的机械通气患者的痰培养结果和致病菌的耐药情况。结果在102例机械通气患者中，发生呼吸机相关性肺炎70例，发病率68．6％。检出致病菌157株，其中革兰阴性菌92株（58．6％），革兰阳性菌35株（22．3％），真菌30株（19．1％）。铜绿假单胞菌和耐甲氧西林金黄色葡萄球菌各22株（各占14．0％），嗜麦芽窄食假单胞菌21株（13．4％），鲍曼不动杆菌17株（10．8％）。在70例呼吸机相关性肺炎患者中，单一致病菌感染11例，混合感染59例（84.3％），其中31例为2种致病菌感染，28例为3种致病菌感染。结论EICU呼吸机相关性肺炎患者中最常见的致病菌为铜绿假单胞菌、耐甲氧西林金黄色葡萄球菌、嗜麦芽窄食假单胞菌和鲍曼不动杆菌。真菌感染有上升趋势，但仍以白色念珠菌为主。致病菌存在多重耐药和广泛耐药的情况。

Objective To observe the pathogens and drug-resistance of ventilator - associated pneumonia （VAP） patients in emergency intensive care unit （EICU） for rational antibiotic therapy and the prevention of VAP. Method The sputum culture results and drug-resistance of pathogens of VAP patients in EICU from 2007 to 2009 were collected. Results One hundred and two mechanical ventilation patients were selected. VAP was occurred in 70 patients （68.6%）. One hundred and fifty-seven pathogens had been examined,including 92 Gram- negative bacilli （58.6%）, 35 Gram-positive cocci （22.3%） and 30 fungus （19.1%）. Pseudomonas aeruginosa and meticillin-resistant-staphylococcus aureus was 22 strains （14.0%） respectively, stenotrop homonas maltophilia was 21 strains （ 13.4% ） and acinetobacter baumanii was 17 strains （10.8%）. Fifty-nine patients （84.3%） had suffered from multiple pathogen infection, with 31 cases having 2 pathogens and 28 cases having 3 pathogens. Conclnsions Pseudomonas aeruginosa,methicillin- resistant staphylococcus,stenotrophomonas maltophilia and acinetobacter baumanii are main pathogens of VAP in EICU patients,and candida albicans is still the main pathogens in fungal infection. The rate of multiple pathogen infection is very high, and the problem of drug-resistance is very severe.