重症医学科呼吸机相关肺炎的病原学特点分析

Analysis of the Etiologic Characteristics of Ventilator-Associated Pneumonia in Department of Critical Care Medicine

目的:分析重症医学科呼吸机相关肺炎(ventilator-associated pneumonia,VAP)的病原学特点及细菌对抗生素的敏感性,为临床选择抗生素提供依据。方法:回顾分析2012年1月—2013年12月苏州大学附属第三医院重症医学科收治的32例VAP的细菌感染情况及细菌对抗生素的敏感性。结果:32例VAP中检出110株菌,其中革兰阴性杆菌48株(43.6%),以鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌为主;革兰阳性球菌43株(39.1%),以肠球菌、金黄色葡萄球菌、表皮葡萄球菌和溶血葡萄球菌为主;真菌19株(17.3%),以白色念珠菌为主。药敏试验结果显示,鲍曼不动杆菌、肺炎克雷伯菌和大肠埃希菌对碳青霉烯类的敏感率较其他抗生素高,未发现对万古霉素和利奈唑胺耐药的肠球菌和葡萄球菌。结论:重症医学科VAP患者感染革兰阴性杆菌比例稍高于革兰阳性球菌。临床上应根据细菌病原学及对抗生素的敏感性,合理选择抗生素来控制重症医学科内感染的发生,减少耐药菌株的出现。

Objective：To investigate the etiologic characteristics,as well as the sensitivity of bacteria to antibiotics,in ventilator-associated pneumonia（VAP）in Department of Critical Care Medicine,so as to provide evidence for empirical antimicrobial treatment.Methods：The bacterial infection,as well as the sensitivity of bacteria to antibiotics,in32 VAP cases in Department of Critical Care Medicine in The Third Hospital,Soochow University from Jan2012 to Dec 2013 were retrospectively analyzed.Results：A total of 110 strains of bacteria were found from32 VAP cases,including 48 gram negative bacilli（43.6%）,43 gram positive cocci（39.1%）and 19 fungi（17.3%）.Gram negative bacilli mainly consisted of Baumanii and Klebsiella,Pseudomonas aeruginosa and Escherichia coli.Gram positive cocci mainly consisted of Enterococci and Staphylococcus aureus,Staphylococcus epidermidis and Staphylococcus haemolyticus.Fungi mainly consisted of Candida albicans.Drug sensitive test results showed that Baumanii,Klebsiella and Escherichia coli were more sensitive to carbapenems than to other antibiotics and no Enterococci and Staphylococci was found resistant to vancomycin and linezolid.Conclusions：More VAP patients in Department of Critical Care Medicine were infected by gram negative bacilli.In clinical,empirical antimicrobial treatment should be selected reasonably according to the bacterial etiology and the sensitivity of bacteria to antibiotics,so as to control the infection in Department of Critical Care Medicine and reduce the emergence of drug resistant bacteria.