重症监护室呼吸机相关肺炎的病原菌分布和耐药性监测

DISTRIBUTION AND DRUG RESISTANCE MONITOR OF VENTILATOR-ASSOCIATED PNEUMONIA PATHOGENS IN ICU

目的了解医院重症监护室呼吸机相关肺炎病原菌及其耐药性发展趋势,为临床科学用药提供参考。方法通过前瞻性目标监测,对某驻军医院重症监护室(ICU)住院机械通气病人呼吸机相关肺炎(VAP)病原菌进行了监测与分析。结果该医院ICU在2010-2011年期间实施机械通气治疗的病人106例,发生VAP患者48例,发生率为45.3%。从48例VAP患者标本中共分离病原菌85株,其中革兰阴性杆菌占75.29%,革兰阳性球菌占22.35%。此两类病原菌中,以不动杆菌、铜绿假单胞菌和表皮葡萄球菌所占比例最高,对氨苄西林耐药最严重。结论该医院ICU机械通气病人VAP发病率较高,其耐药趋势呈多态性变化,根据药敏试验结果选用抗菌药物至关重要。

Objective To know the hospital ICU ventilator associated pneumonia pathogenic bacteria and its drug resist- ance trend, to provide the reference for clinical scientific medication. Methods Prospective target monitoring was used to monitor and analyze ventilator associated pneumonia （VAP） pathogens of hospitalized patients in a military hospital inten- sive care unit （ICU） with mechanical ventilation. Results 106 patients with mechanical ventilation were treated in ICU during 2010 - 2011. 48 patients had VAP, the incidence rate was 45.3%. From 48 VAP patients, 85 strains of pathogenic bacteria were isolated, Gram negative bacilli accounted for 75.29%, Gram positive cocci accounted for 22.35%. Acineto- bacter, Pseudomonas aeruginosa and Staphylococcus epidermidis occupied the highest proportion of the two kinds of patho- genic bacteria, and serious resisted to ampicillin. Conclusion VAP incidence rate was high in ICU patients with mechani- cal ventilation, and the trend of drug resistance showed polymorphic variation. It was very important to select antibiotics ac- cording to the results of drug sensitive test.