急诊ICU呼吸机相关性肺炎的病原学分析

Analysis of the etiology of ventilator-associated pneumonia in emergency ICU ward

目的探讨急诊ICU呼吸机相关性肺炎的病原学特点。方法以2011年1月至2012年1月入住我院急诊ICU应用呼吸机人工辅助呼吸且被诊断为呼吸机相关性肺炎的23例患者为观察对象,使用一次性无菌吸痰管从患者气管插管内吸取痰液标本,送实验室培养后行菌种鉴定及药敏试验。结果共检出病原菌70株,其中革兰阴性菌48株(占68.6%),排名依次为鲍曼不动杆菌16株、铜绿假单胞菌14株、大肠埃希菌6株、嗜麦芽窄食单胞菌6株、肺炎克雷白菌3株、其他革兰阴性菌3株;革兰阳性菌17株(占24.3%),排名依次为金黄色葡萄球菌12株、溶血葡萄球菌2株、其他革兰阳性菌3株;真菌5株(占7.1%)。大多数革兰阴性菌对亚胺培南及美罗培南敏感,但嗜麦芽窄食单胞菌对亚胺培南及美罗培南完全耐药。结论急诊ICU呼吸机相关性肺炎的主要致病菌为革兰阴性菌,多数革兰阴性菌对亚胺培南及美罗培南敏感,临床上应依据药敏试验结果选择敏感抗生素治疗呼吸机相关性肺炎。

Objective To investigate etiological feature of ventilator-associated pneumonia in emergency ICU ward.Methods 23patients with ventilator-associated pneumonia in emergency ICU ward were chosen as the research object from January 2011to January 2012.Sputum draw from intubation were underwent strain identification and sensitivity testing in laboratory.Results 70pathogens were detected.48Gram-negative bacilli（68.6%）,including 16Acinetobacter baumannii,14Pseudomonas aeruginosa,6Escherichia coli,6Stenotrophomonas maltophilia Aeromonas,3 Klebsiella pneumoniae,3other gram-negative bacteriastrains;17 Gram-positive bacteria（24.3%）,including 12 Staphylococcus aureus,2 Staphylococcus haemolyticus,3other Gram-positive bacteria;5fungi（7.1%）.Most Gram-negative bacteria were sensitive to imipenem and meropenem,but Stenotrophomonas maltophilia Aeromonas fully resistanted to imipenem and meropenem.Conclusion Pathogens of the ventilatorassociated pneumonia is mainly of Gram-negative bacilli,and the majority of gram-negative bacilli are sensitive to imipenem and meropenem.Sensitive antibiotic should be chosen depending on susceptibility testing.