呼吸机相关性肺炎高龄患者病原菌分布及耐药分析

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

目的探讨高龄呼吸机相关性肺炎患者(VAP)病原菌分布及耐药性,为临床合理用药提供参考。方法对2007年1月-2011年6月医院确诊断为VAP的123例高龄患者进行病原菌检查及对抗菌药物耐药性进行回顾性分析。结果共检出病原菌409株,其中革兰阴性菌占86.8%,革兰阳性菌占13.2%;革兰阴性菌中铜绿假单胞菌占24.4%、鲍氏不动杆菌占17.1%、嗜麦芽寡养单胞菌占14.7%、洋葱伯克霍尔德菌占7.6%;革兰阳性菌中以金黄色葡萄球菌为主占8.6%;鲍氏不动杆菌和铜绿假单胞菌对常用抗菌药物的耐药性较高。结论铜绿假单胞菌、鲍氏不动杆菌、嗜麦芽寡养单胞菌、金黄色葡萄球菌、洋葱伯克霍尔德菌,为高龄VAP的主要病原菌,应加强临床合理应用抗菌药物。

OBJECTIVE To examine the categories of pathogens in the elder patients with ventilator-associated pneumonia （VAP） and their drug resistance so as to provide evidence for clinical rational use of antibiotics. METHODS A total of 123 elder patients diagnosed as VAP from Jan 2007 to Jun 2011 were targetedly monitored. The results of antibiotic susceptibility test were retrospectively analyzed. RESULTS Totally 409 bacteria were isolated,of which gram-negative bacteria occupied 86.8%, and gram-positive bacteria occupied 13.2%. Among isolated gram-negative bacteria, Pseudomonas aerugino （24.4%） were the most commonly identified, followed by Acinetobacter baumannii （17.1 % ）, Stenotrophomonas maltophilia （ 14. 7 % ）, and Burkholderia ce pacia （ 7.6 % ）. Among gram-positive bacteria, Staphylococus aureus （8.6%） were the most commonly identified. The antibiotic resistance of the P. aerugino and A. baurnannii were high. CONCLUSION Gram-negative bacteria are the most common in elder VAP patients. The most common potential pathogenic bacteria of VAP in eider patients are P. aeruginosa, A. baurnannii, S. Maltophilia, S. aureus and B. cepacia. Rational clinical use of antibiotics is required.