ICU内呼吸机相关性肺炎的病原茵分布及耐药性分析

The research of pathogenic bacteria distribution in ICU their drug tolerance in Ventilator-Associated pneumonia

目的探讨ICU内呼吸机相关性肺炎(VAP)的病原菌分布及其耐药性,为临床防治提供依据。方法对我院ICU科60例呼吸机相关性肺炎患者的病原菌构成及耐药率进行分析。结果共检出病原菌73株,其中革兰阴性(G-)杆菌占72.6%;革兰阳性(G+)球菌占23.3%;真菌占4.1%。铜绿假单胞菌分离率最高为30.1%,其次为不动杆菌和金黄色葡萄球菌(分别为27.4%和11.0%)。G-杆菌对氨苄西林耐药率最高(90%以上),对碳青霉烯类耐药率最低(15%以下);G+球菌对青霉素类及红霉素耐药率高(60%以上),未发现耐万古霉素的葡萄球菌。结论 ICU呼吸机相关性肺炎病原菌以G-杆菌为主,并且G-杆菌的耐药呈多重耐药性,临床应重视病原菌的检查,有针对性使用抗生素。

Objective To investigate the pathogen spectrum distribution and antimicrobial resistance in ventilator-associated pneumonia in intensive care unit（ ICU） and provide evidence for clinical prevention and treatment. Methods Among 60 patients with ventilator-associated pneumonia in ICU in our hospita1. pathogens distribution and resistance rate were analyzed. Results Among 73 strains of isolated pathogens,the gram-negative bacteria accounted for 72. 6% ,the gram-positive bacteria for 23. 3% ,and the fungi for 4. 1%. The isolating rate of Pseudomonas aeruginosa was the most highest 30. 1% and then was the Acinetobacter and Staphylococcus aurous （ each for 27. 4% and 11. 0% ）. Gram-negative bacillus showed in a high resistance to piperacillin （ above 90% ） ,but high susceptibility to carbapenems（ lower than 15% ）. Gram-positive coccobateria showed a high resisptibility to penicillin and Erythromycin（ above 60% ） ,but not found the strains can resisted the Vancomycin. Conclusion Gram-negative bacteria was the majority of the pathogens isolated from patients with ventilator-associated pneu. monia in ICU. Clinical doctors should think highly of pathogen detection and rational application of antibiotics.