98例迟发性呼吸机相关性肺炎患者的病原学及耐药性监测

Pathogenesis and drug resistance in 98 Patients with late-onset ventilator-associated pneumonia

目的探讨迟发性呼吸机相关性肺炎（VAP）患者的病原菌分布和耐药性。方法将98例被确诊为迟发性VAP的机械通气患者进行病原学分布和耐药状况监测。结果纤维支气管镜采样98例共检出致病菌168株，革兰阴性菌占82．9％．其中非发酵菌占5012％，肠杆菌科占3217％；革兰阳性菌占1315％；真菌占4．6％。前3位致病菌分别为鲍氏不动杆菌（26．9％）、铜绿假单胞菌（13．6％）和肺炎克雷伯菌（10．5％）。药敏结果显示前几位革兰阴性菌对常用抗菌药物均有较高耐药性，草兰阳性茵均对万古霉素敏感。结论迟发性VAP的病原菌以革兰氏阴性茵为主，且呈现多重耐药现象，合适的经验性抗菌药物治疗应根据病原学与耐药性的监测结果。

Objective To probe the pathogenesis and their resistance to antibiotics of late-onset ventilator-associated pneumonia （VAP）. Methods A clinical trial in late-onset VAP episodes of 98 patients receiving mechanical ventilation, The pathogenesis and their resistance to antibiotics were analyed. Results A total of 168 pathogen strains were isolated through fiberbronchoscopy by bacterial culture,The Gram-negative bacteria （GNB） were 82.9%, Non-fermenters were 51.4% and Enterobacteriaceae were 32.7% among it ,The Gram-positive bacteria were 13.5%,the fungi 4.6%.The top three pathogen strains with VAP were Acinetobacter baumanii（26.9%）,Pseudomonas aeruginosa（13.6%）,Klebsiella pneumoniae（10.5%） .GNB were highly resistant to common antimicrobials and demonstrated multi-drug resistance, Drug resistance of the Gram-positive bacteria to vancomycin was Conclusion The major pathogenic bacteria in late-onset VAP is GNB, and there are often demonstrated multi-drug resistance,It is suggested that empiric antimicrobial therapy for patients with late-onset VAP should base on the surveillance of etiology and resistance.