ICU呼吸机相关性肺炎病原菌构成与耐药性分析

Distribution and drug resistance of pathogens causing ventilator-associated pneumonia in ICUs

目的调查ICU呼吸机相关性肺炎的病原菌分布和耐药性,为临床合理选择抗菌药物提供依据。方法对2012年3月-2014年3月96例ICU呼吸机相关性肺炎患者分泌物进行病原菌分离、培养鉴定,采用K-B纸片法进行药敏试验分析。结果从96例呼吸机相关性肺炎患者分泌物中共分离出106株病原菌,以革兰阴性菌为主占70.8%,明显高于革兰阳性菌的29.2%(P<0.05);鲍氏不动杆菌、肺炎克雷伯菌和铜绿假单胞菌是主要革兰阴性菌,分别占21.7%、14.2%和10.4%,金黄色葡萄球菌、表皮葡萄球菌和肺炎链球菌是主要革兰阳性菌,分别占11.3%、7.5%和6.6%;主要革兰阴性菌对青霉素、氨苄西林、头孢唑林、头孢噻肟的耐药率均>80.0%,对亚胺培南最为敏感,耐药率<20.0%;金黄色葡萄球菌对青霉素、氨苄西林、头孢唑林、头孢噻肟、头孢呋辛的耐药率均>80.0%,对头孢哌酮/舒巴坦、环丙沙星、阿米卡星相对敏感,耐药率<30.0%,未发现对万古霉素的耐药菌株。结论 ICU呼吸机相关性肺炎以革兰阴性菌为主,耐药现象较为严重,应引起临床人员的重视。

OBJECTIVE To investigate the distribution and drug resistance of pathogens causing ventilator‐associat‐ed pneumonia in ICUs so as to provide guidance for reasonable clinical use of antibiotics .METHODS A total of 96 patients with ventilator‐associated pneumonia who were treated in the ICUs from Mar 2012 to Mar 2014 were en‐rolled in the study ,then the secretions specimens were collected from the participants so as to perform the isola‐tion ,culture ,and identification of pathogens ,and the drug susceptibility testing was carried out by using K‐B disk method .RESULTS Totally 106 strains of pathogens were isolated from the secretions specimens that were obtained from the 96 patients with ventilator‐associated pneumonia ,of which 70 .8% were gram‐negative bacteria ,and 29 .2% were gram‐positive bacteria （P〈 0 .05） .The Acinetobacter baumannii , Klebsiella pneumoniae ,and Pseudomonas aeruginosa were dominant among the gram‐negative bacteria ,accounting for 21 .7% ,14 .2% ,and 10 .4% ,respectively ;the Staphylococcus aureus , Staphylococcus epidermidis ,and Streptococcus pneumoniae were the predominant species of gram‐positive bacteria ,accounting for 11 .3% ,7 .5% ,and 6 .6% ,respectively . The drug resistance rates of the main gram‐negative bacteria to penicillin ,ampicillin ,cefazolin ,and cefotaxime were more than 80 .0% ;the strains were most susceptible to imipenem ,with the drug resistance rate less than 20 .0% .The drug resistance rates of the S .aureus strains to penicillin ,ampicillin ,cefazolin ,cefotaxime ,and ce‐furoxime were more than 80 .0% ;the strains were relatively susceptible to cefoperazone‐sulbactam ,ciprofloxacin , and amikacin ,with the drug resistance rates less than 30 .0% ;the vancomycin‐resistant strains were not found . CONCLUSION The gram‐negative bacteria are dominant among the pathogens causing the ventilator‐associated pneumonia in the ICUs and are highly resistant to antibiotics ,which the clinical staff should pay high attention to .