呼吸机相关性肺炎常见病原菌及耐药性分析

The Analysis of Common Pathogens of Ventilator-associated Pneumonia and Drug Resistance

目的了解呼吸机相关性肺炎(VAP)患者病原菌情况,探讨其细菌耐药性及治疗策略。方法通过查阅2008年1月-2009年12月呼吸与危重症医学科收治的128例VAP患者的病历资料,分析其肺部感染病原菌分布特点及耐药率。结果 VAP平均发病时间为机械通气后5.8 d,总病死率为35.1%(45/128)。共分离出病原菌262株,其中G杆菌210株(占80.2%),G+球菌38株(占14.5%),真菌14株(占5.3%)。G杆菌中占前3位的分别是鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷白杆菌,对青霉素类、头孢菌素类抗菌药物高度耐药,而对亚胺培南等耐药率相对较低;G+球菌主要是金黄色葡萄球菌,其中耐甲氧西林的金黄色葡萄球菌对多种常见抗菌药物高度耐药,而对万古霉素敏感。结论 VAP的主要病原菌为G杆菌,常为多重耐药的致病菌,应根据药敏结果选用合理的抗菌药物。

Objective To investigate the characteristics of pathogens in patients with ventilator-associated pneumonia（VAP） and research on the drug resistance,in order to promote the treatment strategies.Methods The medical records of patients with VAP who were treated in Respiratory and Critical Care Medicine Department in our hospital from January 2008 to December 2009 were reviewed,and the clinical characteristics of etiological germs and the rate of drug resistance in these bacteria were analyzed.Results The average time of onset of VAP was 5.8 days after mechanical ventilation,and total mortality was 35.1%（45/128）.A total of 262 strains of pathogens were isolated from sputum,among which gram-negative bacillus were found in 210 strains（80.2%）,gram-positive cocci in 38 strains（14.5%）,and fungi in 14 strains（5.3%）.The top three pathogens of gram-negative bacteria were acinetobacter baumannii,pseudomonas aeruginosa,and klebsiella pneumonia,all of which had high resistance to penicillins and cephalosporins,but had relatively lower resistance to imipenem.The most common gram-positive bacteria was staphylococcus aureus,of which Methicillin-resistant staphylococcus aureus had high resistance to many common antibiotics but was sensitive to vancomycin.Conclusions The main bacteria in patients with VAP are gram-negative bacilli which are often multidrug-resistant pathogens.Thus,more attention should be paid to the selection of antibiotics in treatment of VAP according to drug susceptibility testing.