呼吸机相关性肺炎病原菌分布与抗菌药物敏感性分析

Distribution and drug susceptibility of pathogenic bacteria causing ventilator-associated pneumonia

目的研究呼吸机相关性肺炎(VAP)病原菌分布及其耐药性,为临床用药提供参考依据。方法采用回顾性调查方法,对2011年1月1日-2015年12月31日432例VAP患者的痰培养结果进行统计分析;采用法国生物梅里埃公司自动微生物鉴定系统进行细菌鉴定,药敏试验采用MIC法;采用SPSS19.0软件对数据进行统计分析。结果 432例VAP患者中共检出病原菌798株,其中革兰阴性菌557株占69.80%,以鲍氏不动杆菌、大肠埃希菌为主;革兰阳性菌205株占25.69%,以金黄色葡萄球菌为主;真菌36株占4.51%;革兰阴性菌中鲍氏不动杆菌除对阿米卡星、磺胺甲噁唑/甲氧苄啶耐药率较低外,对其他药物的耐药率均>90.0%;大肠埃希菌对哌拉西林/他唑巴坦、亚胺培南、阿米卡星、美罗培南较敏感;铜绿假单胞菌对亚胺培南、头孢替坦、美罗培南敏感度较高,对氨苄西林100.0%耐药;革兰阳性菌中金黄色葡萄球菌对替加环素、万古霉素、呋喃妥因、利奈唑胺敏感;屎肠球菌对环丙沙星、克林霉素、红霉素、左氧氟沙星、莫西沙星全耐药,对万古霉素、利奈唑胺、替加环素敏感。结论临床在使用抗菌药物前要尽早进行细菌培养,根据药敏试验结果选择敏感性高的抗菌药物,提升疾病治疗效果,避免产生耐药菌。

OBJECTIVE To explore the distribution and drug resistance of pathogenic bacteria causing ventilator-associated pneumonia（VAP）so as to provide guidance for clinical use of antibiotics.METHODS By means of retrospective survey,the results of sputum culture for 432 VAP patients were statistically analyzed from Jan 1,2011 to Dec 31,2015,the pathogenic bacteria were identified by using automatic microorganisms identification system of BioMérieux,France,the drug susceptibility testing was carried out through MIC method,and the statistical analysis of data was performed with the use of SPSS19.0software.RESULTS A total of 798 strains of pathogenic bacteria were isolated from the 432 patients with VAP,including 557（69.80%）strains of gram-negative bacteria,205（25.69%）strains of gram-positive bacteria,and 36（4.51%）strains of fungi;the Acinetobacter baumannii and Escherichia coli were dominant among the gram-negative bacteria;the Staphylococcus aureus was the predominant species of gram-positive bacteria.Among the gram-negative bacteria,the drug resistance rates of the A.baumannii to amikacin and sulfamethoxazole-trimethoprim were relatively low,while the drug resistance rate to other antibiotics was more than 90.0%;the E.coli strains were highly susceptible to piperacillin-tazobactam,imipenem,amikacin,and meropenem;the Pseudomonas aeruginosastrains were highly susceptible to imipenem,cefotetan,and meropenem,while the drug resistance rate to ampicillin was 100.0%.Among the gram-positive bacteria,the S.aureus strains were susceptible to tigecycline,vancomycin,macrodantin,and linezolid;all of the Enterococcus faecium strains were resistant to ciprofloxacin,clindamycin,erythromycin,levofloxacin,and moxifloxacin,however,the strains were susceptible to vancomycin,linezolid,and tigecycline.CONCLUSIONIt is necessary for the hospital to conduct the bacterial culture as early as the antibiotics are used and choose sensitive antibiotics based on the results of drug susceptibility testing so as to improve the therapeutic effect and avoid the emergence of drug-resistant bacteria.