呼吸机相关肺炎56例临床分析

Ventilator-associated pneumonia: a clinical analysis of 56 cases

目的 总结呼吸机相关肺炎的细菌感染状况 ,供临床用药借鉴。方法 对 5 6例使用呼吸机所致下呼吸道感染患者的分泌物进行培养、分离、鉴定。以K -B法进行药敏试验。结果 共获得致病菌 71株 ,其中革兰阴性杆菌 49株 ,以铜绿假单胞菌、不动杆菌、阴沟杆菌为主 ;革兰阳性球菌 19株 ,以表皮葡萄球菌、金黄色葡萄球菌为主 ;真菌 3株。药敏试验显示细菌耐药现象严重 ,革兰阴性杆菌对舒普深敏感性最高 ,革兰阳性球菌对万古霉素敏感性最高。结论 呼吸机相关肺炎以革兰阴性杆菌感染为主 ,铜绿假单胞菌、不动杆菌、阴沟杆菌为核心致病菌 ,结合药敏联合应用抗生素值得临床重视 。

Objective To investigate into the conditions of microbial infection in the patients with ventilator-associated pneumonia (VAP) to summarize the spectrum of the pathogens and their susceptibilities to drugs. Methods Qualified sputum specimens, taken from 56 inpatients with VAP from 1997 to 2000, were cultured for bacterial identification. Their drug susceptibility to commonly used antibiotics was determined by K-B methods. Results 71 strains of pathogenic bacteria were obtained, i.e. 49 strains of gram-negative bacillus (mainly composed of Pseudomonas aeruginose, A. calcoaeticus and E. cloacae), 19 gram-positive staphylococcus (mainly S. epidermidis and S. aureus) and 3 strains of fungus. Drug susceptibility showed that the drug resistance was very remarkable, only with sulperazon relatively sensitive to gram-negative bacilli and vancomycin relatively sensitive to gram-positive cocci. Conclusion The above-mentioned gram-negative bacilli are the major causative germs of VAP. Much attention should be paid to rational use of antibiotics after drug susceptibility tests and to the elimination of risk factors of VAP.