呼吸机相关性肺炎中革兰氏阴性杆菌分布和耐药性分析

目的:了解综合重症监护病房(ICU)呼吸机相关肺炎(VAP)的革兰氏阴性杆菌分布和耐药情况,为临床诊断与治疗提供参考依据。方法:对我院综合ICU2006年1月至2009年11月使用有创机械通气患者中出现VAP患者进行病案调查,并对临床资料、病原菌分布以及药敏结果进行统计分析。结果:我院综合ICU294例VAP患者病原菌以革兰氏阴性杆菌为主,占68.65%,其中铜绿假单胞菌居首位占22.76%,泛耐药株(PDR-PA)占该菌中的11.90%;鲍曼不动杆菌居第2位占20.54%,泛耐药株(PDR-Ab)占该菌中的27.63%;肠杆菌科细菌占19.19%,产ESBLs的菌株占其中的57.75%;革兰氏阳性菌占19.67%,其中耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检测率分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌中的52.00%和95.42%。结论:我院综合ICU的VAP患者病原菌以革兰氏阴性杆菌为主,应加强对有创机械通气患者下呼吸道分泌物的病原学和耐药性的动态监测;临床分离细菌的耐药性较强,特别是产ESBLs肠杆菌科细菌、多药耐药非发酵菌等十分普遍,经验性抗感染治疗应覆盖耐药菌。临床医师应在本地病原学和耐药性分析的指导下使用抗生素。

Objective ：To supply for treatment advice by investigating the Gram - negative bacillus and drug resistance of pathogens of ventilator - associated pneumonia （VAP） in general intensive care unit （ICU）. Methods：Statistical Methods were used to analyze retrospectively the data of pathogens and drug resistanee of VAP in general ICU from 2006 to 2009. Results：Totally 539 pathogens were isolated from deep - part secretion of lower respiratory tracts of 294 VAP in general ICU. Gram - negative bacillus （68.65 % in all） was the main pathogen of VAP in general ICU. It included 22.76% of Pseudomonas aeraginosa（PA） ,20.54% of Acinetobacter baumanii（AB） and 19.19% of enterobacteria. In which, PDR - PA was.about 11.90% in PA and PDR - Ab was about 27.63% in Ab. ESBLs（ ＋ ） strain was about 57. 75 % in enterobacteria. Gram - positive coccobacteria was 19.67%, MRSA and MRCNS was 52.00% and 95.42%. Condusion ：Gram - negative bacillus was the main pathogen of VAP in general ICU ,it was neccesary to monitor Pathogens and Antibiotic Resistance. muhidrug resistance was serious and ESBLs（ ＋ ） enterobacteria and non - fermenters were popular in the ICU, so antibiotic must be selected to ocupy the Pathogens above. It was suggestted for Clinician to apply antibiotics reasonably according to the data of the bacteria pathogen and antibiotics susceptibity.