呼吸机相关肺炎的痰菌分布及耐药性分析

Distribution of sputum bacterium and analysis of resistance to antibiotics in ventilator-associated pneumonia

目的 :了解呼吸机相关肺炎的痰菌分布及耐药性特征。方法 :收集呼吸机相关肺炎的深部脓痰进行痰菌分离培养 ,并对其药敏试验情况进行分析。结果 :主要是革兰氏阴性杆菌 97.5 %、前几位的革兰氏阴性杆菌分别为铜绿假单胞菌 42 .5 %、肺炎克雷伯菌 14 .2 %、不动杆菌 12 .5 %、大肠埃希菌 9.2 %、阴沟杆菌 5 .8%等。青霉素、红霉素、头胞唑林对铜绿假单胞菌的耐药率为 10 0 % ,亚胺培南、头孢他啶对铜绿假单胞菌的耐药率亦分别达 19.6 %和 2 7.5 %。肺炎克雷伯菌及大肠埃希菌对头胞三嗪、头孢哌酮亦有较高的耐药性。不动杆菌对所监测的抗生素广谱耐药 ,亚胺培南对不动杆菌的耐药率为 7.1%。阴沟杆菌对亚胺培南、头孢他啶未发现耐药株 ,而对其他抗生素耐药性较高。结论 :呼吸机相关肺炎的病原菌主要是革兰氏阴性杆菌 ,其均有严重的耐药性 ,加强耐药性监测 。

Objective:To probe the distribution of sputum bacterium and the character of resistance to antibiotics in ventilator associated pneumonia (VAP) Method:The deep purulent sputum in respiratory tract of the patients with VAP were collected,then bacteria were isolated and cultured,and their antibiotics sensibility test were analysed Results:The major pathogenic bacteria in VAP are Gram negative bacilli (account for 87 5%) Among them,the percentage of Aeruginous pseudomonas,Bacillus canalis capsulatus,Amotile bacilli,Escherichia coli,Bacillus levans is 42 5%,14 2%,12 5%,9 2%,5 8%,respectively The drug fast rate of penicillin,erythromycin,cefazolin to Aeruginous pseudomonas is 100%,and imipenem is 19 6%,ceftazidime is 27 5% accordingly Higher drug fast rate to ceftriaxone and cefoperazone can be observed in aptients infected with Bacillus canalis capsulatus and Escherichia coli Amotile bacilli has broad spectrum resistance to all testing antibiotics,and imipenem has a drug fast rate of 7 1% to Amotile bacilli Bacillus levans has higher drug fast rate to most antibiotics except imipenem and ceftazidime Conclusion:Gram negative bacilli is the major pathogenic bacteria of ventilator associated pneumonia,and most of them have severe resistance to antibiotics It's very important to enhance monitoring of resistance to antibiotics and use antibiotics rationally