老年患者呼吸机相关性肺炎病原体分布与耐药性调查

Distribution and drug resistance of pathogens causing ventilatorassociated pneumonia in elderly patients

目的调查分析2009-2014年呼吸机相关性肺炎(VAP)老年患者病原体分布及耐药性特点,为临床诊疗提供依据。方法选择国内权威性数据库"中国知网"下的中国期刊全文数据库及"医药卫生资源共享数据库"下的外文期刊全文数据库;采用"自由词"检索:以"呼吸机相关性肺炎"为自由词检索出5 043条记录,从5 043条记录结果中再次输入自由词"病原体"检索出1 067条记录,分别以"耐药性"和"老年患者"检索出105条文献记录;从命中的文献中筛选2009-2014年文献共86篇,下载全文;阅读原文分析其临床资料、病原体分布与构成、药物敏感性试验及预后,进行分类归纳、统计汇总。结果 36篇文献被采纳;老年VAP共2 595例;检出病原体共4 129株,其中,革兰阴性菌有3 149株占76.26%,革兰阳性菌644株占15.60%,真菌326株占7.90%,非典型病原体10株占0.24%;革兰阴性菌对氨苄西林、头孢噻肟、头孢曲松、环丙沙星等耐药率较高;金黄色葡萄球菌对氨苄西林、阿莫西林、头孢唑林、亚胺培南、庆大霉素等耐药率较高。结论老年患者是发生VAP的高发人群,革兰阴性菌是老年VAP的主要致病菌,病原菌耐药率普遍较高,临床应该重视病原学监测,根据药敏试验结果合理用药。

OBJECTIVE To investigate the distribution and drug resistance of the pathogens causing ventilator-asso- ciated pneumonia （VAP） in the elderly patients so as to provide guidance for clinical diagnosis and treatment. METHODS The Chinese periodical full text database was selected from ＇China National Knowledge Infrastructure＇, an authoritative database in China, and the foreign periodical full text database was chosen from ＇Medicine ＆ health resource sharing database＇. By means of retrieval with ＇free word＇, totally 5053 records were retrieved by setting ＇ventilator-associated pneumoniat as the free word, from which 1067 records were retrieved by setting ＇pathogen＇ as the free word, and 105 literature records were retrieved by respectively setting ＇drug resistance＇ and ＇elderly patient＇ as the free words. Totally 86 articles that were published from 2009 to 2014 were screened from the appointed literatures and downloaded. The full texts were reviewed to analyze the clinical data, distribution of pathogens, drug susceptibility testing, and prognosis, which were classified, concluded, and taken for statistics. RESULTS Totally 36 articles were included in the study. A total of 4 129 strains of pathogens were isolated from 2 595 elderly patients, including 3 149 （76.26%） strains of gram-negative bacteria, 644 （15. 60%） strains of gram-positive bacteria, 326 （7.90%） strains of fungi, and 10 （0.24%） strains of atypical pathogens. The gram- negative bacteria were highly resistant to ampicillin, cefotaxime, ceftriaxone, and ciprofloxacin. The Staphylococcus aureus strains were highly resistant to ampicillin, amoxicillin, cefazolin, imipenem, and gentamicin. CONCLUSION The elderly patients are the population at high risk of VAP, the gram-negative bacteria are dominant among the pathogens causing the VAP. The drug resistance rates o{ the pathogens are generally high. It is necessary for the hospital to pay attention to the etiological surveillance and reasonably use antibiotics based on the results o{ the drug susceptibility testing.