急诊监护病房老年患者呼吸机相关性肺炎的病原菌分布及耐药性分析

Distribution and antimicrobial resistance of pathogens isolated from elderly patients with ventilator-associated pneumonia in EICU

目的观察急诊监护病房(EICU)老年患者呼吸机相关性肺炎的病原菌分布及耐药特点,为临床合理使用抗菌药物提供依据。方法回顾性分析2012年6月至2017年6月EICU收治的230例老年呼吸机相关性肺炎(VAP)患者的临床资料,分析其病原菌构成及其药物敏感性。结果 230例送检标本共分离出312株病原菌,其中革兰阴性菌227株,占72.8%,革兰阳性菌57株,占18.3%,真菌28株,占9.0%。药敏试验结果显示:鲍曼不动杆菌的耐药现象最为严重,仅对阿米卡星及头孢哌酮/舒巴坦较为敏感。肺炎克雷伯菌、大肠埃希菌和阴沟肠杆菌对亚胺培南、美罗培南、阿米卡星、头孢哌酮/舒巴坦及哌拉西林/他唑巴坦敏感度较高。铜绿假单胞菌对阿米卡星、哌拉西林/他唑巴坦、左氧氟沙星和环丙沙星敏感度较高。金黄色葡萄球菌、肠球菌和表皮葡萄球菌对利奈唑胺、万古霉素和替加环素100%敏感。多数致病菌耐多种抗生素。结论 EICU老年VAP以革兰阴性菌感染为主,多数致病菌呈多重耐药,抗菌药物治疗应以病原学及细菌耐药性监测结果为依据。

Objective To explore the distribution and antimicrobial resistance of pathogens in elderly patients with ventilator-associated pneumonia( VAP) in emergency intensive care unit( EICU),provide a reference for clinical reasonable use of antibiotics. Methods Two hundred and thirty elderly patients with VAP in EICU of our hospital from June 2012 to June 2017 were analyzed retrospectively. The pathogens and their antimicrobial susceptibility were detected and analyzed. Results Three hundreds and twelve strains of pathogenic bacteria were isolated from 230 patients,including 227 strains of gram-negative bacteria,accounting for 72. 8%;57 strains of gram-positive bacteria accounting for 18.3%;28 strains of fungi,accounting for 9. 0%. Drug Susceptibility test showed that the antimicrobial resistance of Acinetobacter baumannii was the most severe,and only sensitive to amikacin,cefoperazone/sulbactam. Klebsiella pneumoniae,Escherichia coil and Enterobacter cloacae were susceptible to imipenem,metropenem,amikacin,cefoperazone/sulbactam and pipercillin/tazobactam. Pseudomonas aeruginosa was sensitive to amikacin,pipercillin/tazobactam,levofloxacin and ciprofloxacin. Staphylococcus aureus,Enterococcus and Staphylococcus epidermidis were susceptible to linezolid vancomycin and tigecycline. Most pathogens were resistant to multiple antibiotics. Conclusions Gram-positive bacteria are the main pathogens in elderly patients with VAP of EICU. Most pathogens are resistant to multiple antibiotics,which suggests that antibiotic therapy should be based on etiology and antimicrobial resistance surveillance results.