ICU呼吸机相关性肺炎病原菌分布和耐药性分析

Distribution and drug resistance of pathogens in ventilator-associated pneumonia in ICU

目的了解我院ICU呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的病原菌分布和耐药性状况,为临床合理应用抗菌药物提供病原学依据。方法回顾性分析2014年1月—2016年12月我院ICU诊断为VAP的118例患者的基本资料,并分析气管深部分泌物的病原菌的构成比和药敏试验结果。结果从118例VAP确诊患者气管深部分泌物中共检出130株病原菌。其中革兰阴性菌103株(79.23%),革兰阳性菌20株(15.38%),真菌7株(5.38%)。革兰阴性菌主要包括:鲍曼溶血不动杆菌33株(32.04%),粘质沙雷菌20株(19.42%)、肺炎克雷伯杆菌18株(17.47%),铜绿假单胞菌11株(10.68%),大肠埃希菌10株(9.71%);革兰阳性菌主要为金黄色葡萄球菌10株(50.00%)。其中粘质沙雷菌、肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌对亚胺培南和阿米卡星的耐药率均低于10.00%,而鲍曼溶血不动杆菌对多种常见抗生素的耐药率均超过80.00%(美罗培南81.97%、阿米卡星83.61%、头孢曲松88.33%、左氧氟沙星80.33%)。金黄色葡萄球菌对万古霉素、利奈唑胺和替考拉宁均敏感。结论我院ICU中VAP患者感染主要以革兰阴性菌为主,且存在多重耐药现象。了解VAP的病原菌分布和耐药性,对于合理应用抗生素、提高治愈率等方面有极大帮助。

Objective To analyze the distribution and drug resistance of pathogenic bacteria of ventilator-associated pneumonia （VAP） in ICU of our hospital to provide the retional drugs for the clinical application. Methods A retrospective analysis of the basic data of 118 VAP patients from January 2014 to December 2016 in ICU of Huainan First People＇ s Hospital, and the pathogens and drug resistance constituent ratio of the deep tracheal secretions of analysis the pathogenic bacteria and drug sensitivity results had been done. Results One hundred and thirty strains pathogenic bacteria were detected from the deep tracheal secretions of 118 patients with VAP, of which there were 103 strains Gram negative bacteria （79.23%）, 20 strains Gram positive bacteria （15.38%） and 7 strains fungi （5.38%）. Gram negative bacteria included： 33 strains Bauman Acinetobacter haemolyticus （32.04%）, 20 strains Serratia marcescens （19.42%）, 18 strains Klebsiella pneumoniae （17.47%）, 11 strains Pseudomonas aeruginosa （10.68%）, 10 strains Escherichia coli （9.71%）. Gram positive bacteria were 10 strains Staphylococcus aureus （50.00%）. And Serratia marcescens, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli resistant to imipenem and amikacin rate were lower than 10.00%, and Bauman Acinetobacter haemolyticus resistance to a variety of common antibiotic rate was more than 80.00% （meropenem 81.97%, amikacin 83.61%, ceftriaxone 88.33%. and levofloxacin 80.33%）. Serratia marcescens, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli were sensitive to carbapenems and amikacin, and Bauman Acinetobacter haemolyticus generally was resistant to multiple antibiotics. Staphylococcus aureus was sensitive to vancomycin, linezolid and teieoplanin. Conclusions VAP infection in ICU of our hospital is mainly Gram negative bacteria, and there are variety of drug resistances. Understanding the distribution and drug resistance of pathogenic bacteria of VAP is of great help to the rational use of antibiotics and the improvement of cure rate.