ICU呼吸机相关性肺炎患者病原菌分布及耐药性分析

Pathogen Distribution and Drug Resistance of Patients with Ventilator Associated Pneumonia in ICU

目的分析ICU呼吸机相关性肺炎(VAP)患者病原菌分布及耐药性。方法选取武汉市黄陂区人民医院ICU 2013年2月—2015年1月收治的VAP患者162例,回顾性分析患者的病历资料,分析其病原菌分布及耐药情况。结果 162份标本中培养分离出病原菌266株,其中革兰阴性菌202株(75.7%)、革兰阳性菌64株(24.3%)。革兰阴性菌以铜绿假单胞菌(占33.2%)、肺炎克雷伯菌(占24.8%)为主;革兰阳性菌以金黄色葡萄球菌(占53.1%)为主。铜绿假单胞菌对复方磺胺甲噁唑、头孢西丁的耐药率较高,分别为91.0%、79.0%;对亚胺培南的耐药率较低,为10.4%。肺炎克雷伯菌对环丙沙星、庆大霉素的耐药率较高,分别为82.0%、72.0%;对亚胺培南的耐药率较低,为4.0%。大肠埃希菌对哌拉西林、头孢曲松、头孢他啶的耐药率较高,分别为94.4%、86.1%、86.1%;对亚胺培南的耐药率较低,为2.8%。嗜麦芽寡养单胞菌对除头孢哌酮/他唑巴坦和复方磺胺甲噁唑之外的常用抗菌药物的耐药率较高,均为75.0%及以上。金黄色葡萄球菌和表皮葡萄球菌对甲氧西林的耐药率分别为94.1%、80.0%,但耐甲氧西林金黄色葡萄球菌和耐甲氧西林表皮葡萄球菌对替考拉宁和万古霉素的敏感率均为100.0%。结论 ICU VAP患者以革兰阴性菌感染为主,且大多数革兰阴性菌对亚胺培南较敏感。

Objective The analyze the pathogen distribution and drug resistance of patients with ventilator associated pneumonia in ICU. Methods From February 2013 to January 2015,a total of 162 patients with ventilator associated pneumonia were selected in ICU,the People＇s Hospital of Huangpi District,Wuhan,and their clinical data was retrospectively analyzed,mainly analyzed the pathogen distribution and drug resistance. Results A total of 266 strains were segregated out from the 162 samples,including 202 strains of Gram- negative bacteria（ accounting for 75. 7%） and 64 strains of Gram- positive bacteria（ accounting for 24. 3%）. Of the Gram- negative bacteria,mainly included pseudomonas aeruginosa（ accounting for 33. 2%）and klebsiella pneumoniae（ accounting for 24. 8%）; of the Gram- positive bacteria,mainly included staphylococcus aureus（ accounting for 53. 1%）. Drug resistance rate of pseudomonas aeruginosa was 91. 0% to trimethoprim/sulfamethoxazole,was79. 0% to cefoxitin,was 10. 4% to imipenem. Drug resistance rate of klebsiella pneumoniae was 82. 0% to ciprofloxacin,was72. 0% to gentamicin,was 4. 0% to imipenem. Drug resistance rate of escherichia coli was 94. 4% to piperacillin,was 86. 1%to ceftriaxone,was 86. 1% to ceftazidime,was 2. 8% to imipenem. Drug resistance rate of stenotrophomonas maltophilia was equal or over 75. 0% to common antibacterial agents（ except cefoperazone / tazobatam and trimethoprim / sulfamethoxazole）. Drug resistance rate of staphylococcus aureus and staphylococcus epidermidis to methicillin was 94. 1% and 80. 0%,respectively,but the antibiotic sensitive rates of methicillin- resistant staphylococcus aureus and methicillin- resistant staphylococcus epidermidis to teicoplanin and vancomycin were both 100. 0%. Conclusion Gram- negative bacteria is the main pathogen of patients with ventilator associated pneumonia in ICU,and most of Gram- negative bacteria are sensitive to imipenem.