ICU呼吸机相关性肺炎病原学及其耐药性分析

Pathogen distribution and drug resistance of ventilator-associated pneumonia in a general intensive care unit

目的探讨我院综合ICU呼吸机相关性肺炎(VAP)的病原菌分布及耐药情况。方法对我院ICU诊断为VAP的145例患者病原学资料进行分析。结果检出病原菌185株,其中革兰阴性(G-)杆菌141株(占76.2%),前五位的G-菌分别是铜绿假单胞菌(46株)、肺炎克雷伯菌(24株)、鲍曼不动杆菌(17株)、大肠埃希菌(8株)和洋葱伯克霍尔德菌(8株);革兰阳性(G+)球菌17株(占9.2%),主要为金黄色葡萄球菌(6株),其中耐甲氧西林3株;真菌27株(占14.6%)。铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌和大肠埃希菌耐药率均<30%的抗菌药物有头孢哌酮/舒巴坦、亚胺培南和美洛培南,铜绿假单胞菌耐药率<30%的药物还有头孢他啶、妥布霉素、阿米卡星和奈替米星;洋葱伯克霍尔德菌耐药率<30%的药物有哌拉西林/他唑巴坦、头孢他啶和复方新诺明。万古霉素、替考拉宁仍是院内G+球菌特别是金黄色葡菌球菌的首选药物(耐药率为0%)。结论医院ICU中VAP病原菌以革兰阴性杆菌为主,细菌耐药普遍,临床需动态监测VA P病原菌及其耐药性,合理使用抗菌药物。

Objective To evaluate the pathogen distribution and drug resistance of ventilator-associated pneumonia（VAP） in the general intensive care unit（ICU） of our hospital,and provide a reference for the prevention and treatment of VAP.Method The pathogens isolated in 145 patients who were diagnosed with VAP in the general ICU from January 2004 to December 2010 were retrospectively analyzed.Results 185 strain pathogens were isolated.141（76.2%） strains were Gram negative（G-）,the top five of the G-bacteria were Pseudomonas aeruginosa（46）,Klebsiella pneumoniae（24）,Acinetobacter baumannii（17）,Escherichia coli（8） and Burkholderia cepacia（8）.17（9.2%） strains were Gram-positive（G＋） coccobacteria,mainly Staphylococcus aureus（6）,3 of which were methicillin-resistant strains.27（14.6%） strains were fungi.Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter baumannii and Escherichia coli showed lower resistance rate（〈30%） to cefoperazone/sulbactam,imipenem and meropenem,Pseudomonas aeruginosa also showed lower resistance rate（〈30%） to ceftazidime,tobramycin,amikacin and netilmicin.Burkholderia cepacia showed lower resistance rate（〈30%） to piperacillin/tazobactam,ceftazidime and cotrimoxazole.G＋ coccobacteria showed no resistance to vancomycin and teicoplanin.Conclusion The main pathogens causing VAP in the general ICU were Gram-negative bacilli,bacteria resistance to commonly used antibiotics are serious.Dynamically monitoring of pathogen and its resistance to antibiotics is needed,so as to guide the use of antimicrobial drugs.