呼吸机相关性肺炎病原菌的构成及耐药性临床分析

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

目的分析呼吸机相关性肺炎(VAP)病原菌的分布特点及耐药性,指导临床合理用药。方法对明确行气管插管或气管切开机械通气>48h的87例患者的气管内抽吸物(ETA),进行细菌定量培养及抗菌药物敏感性测定。结果 87例VAP患者ETA培养出病原菌195株,革兰阴性杆菌占75.9%,革兰阳性球菌占14.87%,真菌占9.23%;常见病原菌依次是鲍曼不动杆菌24.1%、铜绿假单胞菌20.51%、耐甲氧西林金黄色葡萄球菌(MRSA)11.79%、肺炎克雷伯杆菌7.18%、嗜麦芽寡养单胞菌7.18%;革兰阴性杆菌首选头孢哌酮舒巴坦和亚胺培南;MRSA对万古霉素100%敏感;真菌对氟康唑的敏感率为100.0%;VAP混合感染者占60.92%。结论 VAP的主要病原菌为革兰阴性杆菌。混合感染现象较严重且存在明显的耐药现象,通过细菌培养和药物敏感性分析,有效指导临床选用合适抗菌药物。

Objective To investigate the distribution and drug resistance characteristic of pathogens in patients with ventilator-associated pneumonia（VAP） and direct clinical doctors to select antibiotics correctly.Methods The endotracheal aspirates of 87 patients received tracheostomy and mechanical ventilation for more than 48 hours was cultured with a quantitative method and their antibiotic susceptibility was detected.Results Gram-negative bacilli（GNB） were the main pathogens in VAP.Among 195 strains of isolated pathogens in 87 patients,the GNB occupied 75.9%,the Gram-positive bacteria were 14.87%,and the fungi were 9.23%.In bacteria isolates,Acinetobacter baumannii（24.1%） was the most commonly identified,followed by Pseudomonas aeruginosa（20.51%）,Meticillin resistant S.aurens（11.79%）,Klebsiella pneumoniae（7.18%）,Stenotrophomonas maltophiliae（7.18%）.GNB were susceptible to cefoperazone sulbactam and imipenem.Aureuswas;Meticillin resistant Staphylococcus aurens still highly susceptible to vancomycin;Candida albicans was susceptible to fluconazole.The mixed infections attained to 60.92%.Conclusion GNB are still the most important pathogens in VAP.Mixed infections are severe and have multiple drug-resistance.Bacterial culture and antibiotic susceptibility tests are very important to select antibiotics correctly for treatment of VAP.