呼吸机相关性肺炎病原菌分布及耐药性分析

探讨呼吸机相关性肺炎（VAP）病原菌的分布特点及其耐药性，以指导临床合理选用抗生素。方法回顾性分析78例VAP患者的病原菌分布及抗菌药物的耐药性。结果78例VAP患者共分离出147株病原菌，其中革兰阴性菌94株（占66．0％），革兰阳性菌32株（占23．1％），真菌21株（占感染10．9％）。革兰阴性菌中以铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌为主，革兰阳性菌中金黄色葡萄球菌和表皮葡萄球菌为主，白色假丝酵母菌及其他假丝酵母菌为真菌感染的主要致病菌。致病菌对常用抗菌药的耐药性普遍为高。结论革兰阴性菌为VAP的主要病原菌，且耐药现象严重，在临床上应加强抗生素的管理，合理选用抗菌药物治疗VAP。

Objective To explore the categories of ventilator associated pneumonia （VAP） pathogens and their drug resistance so as to direct clinical doctors to select antibiotics correctly. Methods The bacterial spectrum and their drug resistance from 78 patients with VAP in our hospital from September 2008 to October 2011 were analyzed retrospectively. Results 147 pathogens were isolated from these 78 patients, of which Gram negative bacteria occupying 66. 0% , the Gram positive bacteria were 23. 1% , and the fungi were 10. 9%. In Gram - negative bacteria isolates, Pseudomonas aeruginosa was the dominant bacteria, followed by Klebsiella pneumonia, Acinetobacter baumannii and Escherichia coli ; And in Gram - positive bacteria, Staphylococcus aureus and Staphylococcus epidermidis were the most commonly identified. Candida albicans were the major pathogens for fungi infections. The antibiotic resistance of the pathogens was increasingly higher. Conclusions GNB are still the most important pathogens in VAP and have Seriously drug resistance. The elevated antibiotic resistance of pathogens requires a rational clinical use of antibiotics, and it＇ s very important to select antibiotics correctly for treatment of VAP.