呼吸机相关性肺炎病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing ventilator-associated pneumonia

目的探讨呼吸机相关性肺炎(VAP)病原菌分布特点及耐药性,指导临床合理用药。方法对97例呼吸机相关性肺炎患者下呼吸道分泌物进行细菌定量培养及抗菌药物敏感性测定。结果 VAP患者共分离出113株病原菌,其中革兰阴性杆菌70株占61.95%,革兰阳性杆菌27株占23.89%,真菌感染16株占14.16%;检出前3位分别是鲍氏不动杆菌、真菌、洋葱伯克霍尔德菌,分别占15.93%、14.16%、12.39%;鲍氏不动杆菌对氨苄西林、哌拉西林均100.00%耐药,洋葱伯克霍尔德菌对氨苄西林、氨曲南的耐药率较高,分别为92.86%、85.71%,对亚胺培南和头孢他啶较敏感,铜绿假单胞菌对氨苄西林、氨曲南、哌拉西林耐药率分别为100.00%、100.00%、91.67%,对亚胺培南、阿米卡星、头孢他啶有较高的敏感性。结论 VAP感染以革兰阴性杆菌为主,耐药率较高,根据病原菌培养和药物耐药性分析结果合理选用抗菌药物,对治疗VAP患者具有重要意义。

OBJECTIVE To investigate the distribution characteristic and drug resistance of pathogens causing ventilator-associated pneumonia（VAP） so as to guide the clinical doctors to select antibiotics correctly. METHODS Retrospective cohort study was conducted to analyze the bacteriology data and drug resistance of lower respiratory tract secretions for a total of 97 VAP patients. RESULTS Among 113 strains of isolated pathogens in 97 patients, there were 70 strains of the gram-negative bacilli （94 ~）, 27 strains of the gram-positive bacteria （23.89 %） and 16 strains of the fungi （14. 16% ）. The Acinetobacter baumaiin （15. 93%）, fungi （14. 16%）, Burkholderia ccpacia （12. 39%/00）, Pseudomonas aeruginosa and Staphylococcus aureus were the main pathogens isolated. A. baurnaiin was resistant to ampicillin （100. 00%） and piperacillin （100. 00%）. B. ccpacia was sensitive to imipenem and ceftazidime, and was resistant to ampicillin （92.86 %） and aztreonam （85.71%） . P. aeruginosa was sensitive to imipenem, amikacin, ceftazidime, and was resistant to ampicillin （100. 00%）, aztreonam （100.00%）, piperacillin （91. 67%）. CONCLUSION The major pathogens causing VAP are gram-negative bacteria, the reasonasce use of antibiotics based on the results of pathogen culture and drug susceptibility testing has great significance to the treatment of VAP.