重症监护病房院内获得性肺炎病原学及耐药性分析

Analysis on the Etiology and Drug Resistance of ICU Patients with Hospital Acquired Pneumonia

目的分析重症监护病房(ICU)院内获得性肺炎(HAP)病原学特点及耐药性。方法选取我院ICU治疗的HAP患者120例为研究对象,对下呼吸道分泌物培养及药敏结果进行回顾性分析。结果1120例HAP患者中,革兰阴性菌占69.17%,以铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌为主;真菌占19.17%,以白假丝酵母菌为主;革兰阳性菌占11.66%;以金黄色葡萄球菌为主。2铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌对青霉素类药物的敏感性普遍较低,平均耐药率>80%;革兰阳性菌对环丙沙星、氨苄西林、青霉素的平均耐药率>70%,但对万古霉素、替考拉宁的敏感性较强;白假丝酵母菌的耐药率较低,但克柔假丝酵母菌耐药性较高。结论 ICU中HAP患者病原菌以革兰阴性菌最为常见,其次为真菌、革兰阳性菌,均存在不同程度的耐药性,与病原菌类型密切相关;应根据患者的病原菌及耐药性,合理选用抗生素。

Objective To analyze the etiology characteristics and drug resistance of ICU patients with hospital acquired pneumonia （HAP）. Methods The results of lower respiratory secretions culture and drug susceptibility in 120 ICU patients with HAP in our hospital were retrospectively analyzed. Results ①Of 120 HAP patients, gram negative bacteria accounted for 69.17%, dominated by pseudomonas aeruginosa, klebsiella pneumoniae, acinetobacter baumannii; fungi accounted for 19.17%, dominated by candida albicaus; gram positive bacteria accounted for 11.66%, dominated by staphylococcus aureus. ② Pseudomonas aeruginosa, klebsiella pneumoniae, acinetobacter baumonnii had lower sensitivity for penicillin drugs, and the average drug resistance rates 〉80%; the average drug resistance rates of gram positive bacteria for ciprofloxacin, ampicillin, penicillin were higher than 70%, but these bacterium were sensitive to vancomycin and teicoplanin. Candida albicans had lower drug resistance, but candida krusei had higher drug resistance. Conclusions The pathogenic bacteria in ICU patients with HAP is dominated by gram negative bacteria, followed by fungi and gram positive bacteria, which is closely related with the type. The reasonable use of antibiotics should be based on patients＇ pathogenic bacteria and drug resistance.