ICU呼吸机相关性肺炎病原菌构成及耐药性分析

Distribution and drug resistance of pathogens causing ventilator-associated pneumonia in ICU

目的分析医院综合ICU呼吸机相关性肺炎(VAP)病原菌的分布特点及其耐药性,为VAP治疗提供合理依据。方法回顾性分析210例VAP患者下呼吸道分泌物细菌培养及药敏结果。结果 210例VAP患者下呼吸道分泌物中共分离出病原菌394株,其中革兰阴性菌308株占78.2%,革兰阳性菌52株占13.2%,真菌34株占8.6%,排前3位病原菌依次为鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌,分别占20.3%、18.8%、16.2%;混合细菌感染者为176例占83.8%,单一细菌感染者为34例占16.2%,耐甲氧西林金黄色葡萄球菌28株、耐甲氧西林表皮葡萄球菌10株;鲍氏不动杆菌对头孢哌酮/舒巴坦较敏感,铜绿假单胞菌对头孢哌酮/舒巴坦和碳青霉烯类药物较敏感,肺炎克雷伯菌对碳青霉烯类药物较敏感,金黄色葡萄球菌耐药现象严重,对万古霉素和替考拉宁较敏感,白色假丝酵母菌对氟康唑、伊曲康唑、伏立康唑较敏感。结论 VAP的主要病原菌为革兰阴性杆菌,耐药现象严重,多数为混合感染,治疗困难;进行细菌培养和药物敏感性试验,对合理选用抗菌药物治疗VAP具有重要意义。

OBJECTIVE To determine the characteristics of distribution of pathogens causing ventilator-associated pneumonia（VAP）in ICU and analyze the drug resistance so as to guide the clinical treatment of VAP.METHODS The result of the bacterial culture of lower respiratory tract secretions obtained from 210cases of VAP and the result of drug susceptibility testing were retrospectively analyzed.RESULTS A total of 394strains of pathogens have been isolated from the lower respiratory tract secretions obtained from the 210cases of VAP,including 308（78.2%）strains of gram-negative bacteria,52（13.2%）strains of gram-positive bacteria,and 34（8.6%）strains of fungi;the Acinetobacter baumannii,Pseudomonas aeruginosa,and Klebsiella pneumoniae ranked the top three species of pathogens,accounting for 20.3%,18.8%,and 16.2%,respectively.There were 176（83.8%）cases of mixed bacterial infections and 34（16.2%）cases of single bacterial infection.Totally 28strains of methicillin-resistant Staphylococcus auseus and 10strains of methicillin-resistant Staphylococcus epidermidis have been isolated.The A.baumannii was highly susceptible to cefoperazone-sulbactam,the P.aeruginosa was highly susceptible to cefoperazone-sulbactam and carbapenems,the K.pneumoniae was highly susceptible to carbapenems,the S. aureus was highly drug resistant but was susceptible to vancomycin and teicoplanin,and the Candida albicans was highly susceptible to fluconazole,itraconazole,and voriconazole.CONCLUSION The gram-negative bacilli are the predominant pathogens causing VAP and are highly drug resistant,and most of the cases are mixed infections, which makes the treatment difficult;it is of great significance in reasonable drug therapy for VAP to perform the bacterial culture and the drug susceptibility testing.