重症监护病房呼吸机相关性肺炎病原菌分布及耐药监测

Distribution of ventilator-associated pneumonia pathogens in intensive care unit and drug resistance surveillance

目的探讨重症监护病房(ICU)呼吸机相关性肺炎的流行病学分布及细菌耐药趋势的变化规律,为临床防治提供参考。方法设计重症监护病房医院感染前瞻性调查表,对医院2007-2008年重症监护病房收治的机械通气>48 h的106例患者进行前瞻性目标监测。结果 106例患者发生呼吸机相关性肺炎的有48例,呼吸机相关性肺炎感染率为45.3%,48例患者中共分离病原菌87株,其中革兰阴性杆菌68株,占78.16%,居前3位的革兰阴性菌依次为:鲍氏不动杆菌、铜绿假单胞菌和肺炎克雷伯菌;革兰阳性球菌19株,占21.84%,以表皮葡萄球菌为主;占革兰阴性杆菌构成比前3位的病原菌对亚胺培南/西司他丁较为敏感,而耐药率最高的药物为氨苄西林;占革兰阳性菌构成比前3位的病原菌对氨苄西林严重耐药,但对万古霉素敏感度高。结论医院重症监护病房呼吸机相关性肺炎常见病原菌耐药趋势呈多态性变化,不动杆菌属的医院肺部感染已经日趋严重;监测重症监护病房病原菌耐药趋势变化对指导患者合理用药,提高临床抗菌药物经验治疗水平和预防或延迟重症监护患者感染至关重要。

OBJECTIVE To investigate the epidemiological distribution intensive care unit（ICU） ventilator-associated pneumonia in the distribution and variation of bacterial resistance,provide a reference for clinical prevention and treatment.METHODS Questionnaire about prospective nosocomial infection during 2007-2008 in intensive care unit was designed.A total of 106 patients treated more than 48 hours of mechanical ventilation were prospectively monitored.RESULTS A total of 48 cases occurred with ventilator-associated pneumonia in 106 patients,which ventilator-associated pneumonia and infection rate was 45.3%.A total of 87 strains of pathogens were isolated from 48 cases of patients,including 68 strains of Gram-negative bacilli,accounting for 78.16%,the Top 3 Gram-negative bacilli were Acinetobacter baumanniii,Pseudomonas aeruginosa as the major pathogens;Gram-positive cocci were 19 strains,accounting for 21.84%,mainly Staphylococcus epidermidis.The top 3 pathogens of Gram-negative bacilli were sensitive to imipenem/cilastatin,and the drug resistant rates to ampicillin was the highest,while top3 pathogens of Gram-positive bacteria were seriously resistant to ampicillin,but were sensitive to vancomycin.CONCLUSION The drug resistant trends of common pathogens causing ventilator-associated pneumonia in ICU are polymorphic changes.Lung infection caused by Acinetobacter has become increasingly serious.Monitoring the drug resistant trends of pathogens in ICU patients is essential to guide the rational drug use,to improve clinical antimicrobial therapeutic levels of drug experience,and to prevent or delay infection in ICU patients.