呼吸机相关性肺炎的病原菌及耐药性分析

Distribution and drug-resistance of pathogens in patients with ventilator-associated pneumonia

目的研究重症监护病房（ICU）内呼吸机相关性肺炎（VAP）的病原菌分布及其耐药性，为临床用药提供参考。方法以我院2007年12月～2008年12月ICU内行有创机械通气患者为研究对象，从中筛选出符合VAP临床诊断标准的病例，回顾性分析VAP的病原菌分布和耐药情况。结果36例VAP患者共培养出病原菌175株，其中G^-杆菌154株，占88％，G^＋球菌15株，占8．6％，真菌6株，占3．4％。位于前5位的病原菌依次为铜绿假单胞菌、嗜麦芽窄食单胞菌、鲍曼不动杆菌、洋葱伯克霍尔德菌、金黄色葡萄球菌。产超广谱β-内酰胺酶（ESBLs）细菌分离率为33．3％。G^-杆菌对常用抗菌药已表现出较高的耐药率，金黄色葡萄球菌耐药现象严重，耐甲氧西林金黄色葡萄球菌（MRSA）占66．7％，但对万古霉素、替考拉宁敏感。结论VAP主要病原菌为G^-杆菌且存在严重的耐药现象，对机械通气患者应严密监测病原菌，合理选用抗生素，加强管理，综合防治VAP。

Objective To investigate the pathogenesis and the drug-resistance of VAP in ICU to provide a reference for the clinical treatment. Methods Retrospective analysis was performed on bacterial distribution and drug-resistance in objects who receiving mechanical ventilation and diagnosing VAP in ICU of the first hospital of China Medical University from Dec 2007 to Dec 2008. Results Among 175 strains of pathogens from 36 VAP patients,the Gram-negative bacilli（GNB） occupied 88% （ 154 strains）, the Gram-positive bacteria （GPB） were 8.6% （ 15 strains ）, and the fungi were 3.4% （6 strains）. The most common pathogens were Pseudomonas aeruginosa, Stenotrophomonas mahophilia, Acinetobacter baumannii, Burkholderia cepacia, and Staphylococcus aureus. ESBLs accounted for 33.3%. The drug resistance of GNB to antibiotics is increasing. Staphylococcus aureus had severe drug-resistance. Methicillin-resistant Staphylococcus aureus accounted for 67.7%, but was still highly susceptible to vancomycin and teicopla- nin. Conclusions The most important pathogens in VAP are the Gram- negative bacilli which drug resist- ance to antibiotics is increasing. To effectively control VAP, extensive and dynamical monitoring of VAP pathogens and rational use of antibiotics were advocated.