先天性心脏病术后呼吸机相关性肺炎致病菌及其耐药性分析

Pathogenic bacteria of postoperative ventilator-associated pneumonia and antibiotic resistance in patients with congenital heart surgery

目的探讨先天性心脏病(先心病)术后发生呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的致病菌分布,分析其耐药性及其变化趋势。方法回顾性分析797例先心病心脏手术患儿的临床资料,对术后发生VAP患儿进行致病菌及耐药性的统计分析。结果 135例患儿术后发生VAP,发生率为16.94%;135例痰标本共检出病原菌289株,包括G-杆菌144株(49.8%),G+球菌87株(30.1%),真菌58株(20.1%);常见G-杆菌为铜绿假单胞菌、肺炎克雷伯杆菌、大肠埃希杆菌等;常见G+球菌为凝固酶阴性葡萄球菌、肺炎链球菌、粪肠球菌等;真菌以类酵母菌为主。结论先心病术后VAP的致病菌以G-杆菌为主,致病菌分布有其自身特点;应重视对VAP病原学监测,根据药物敏感试验合理使用抗生素。

Objective To investigate the distribution of pathogenic bacteria of postoperative ventilator-associated pneumonia （VAP） in patients with congenital heart disease and analyze the antibiotic resistance and developing tendency. Methods The clinical data of 797 patients with congenital heart disease were retrospectively analyzed the pathogenic bacteria and antibiotic resistance in those with postoperative VAP. Results VAP occurred in 135 patients （16.94%）. A total of 289 pathogen strains were isolated by bacterial culture. The main pathogenic bacteria in VAP were Gram-negative bacilli in 144 strains （49.8%）, Gram-positive bacteria in 87 strains （30. 1%）, and fungi in 58 strains （20. 1%）. The main Gram-negative bacilli were P. Aeruginosa, K. Pneumoniae and E. Coli. The main Gram-positive bacteria were coagulase negative staphylococcus, streptococcus pneumonia and enterococeus faecalis. The main fungus was yeast-like fungi. Conclusion The main pathogen of VAP is Gram-negative bacilli and their pathogenic bacteria have special features. Monitoring the pathogenic bacteria and rational use of antibiotics according to drug sensitive tests are important for the prevention and treatment of VAP.