ICU危重症患者呼吸机相关感染的病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing ventilator-associated infections in critically ill patients in ICU

目的 探讨本院ICU危重症患者呼吸机相关感染的病原菌分布特点及耐药性监测分析。方法 选自本院于2016年1月至2017年12月ICU收治行机械通气治疗的561例危急重症患者。从中采集呼吸机相关感染患者65例痰液标本,培养分离出细菌后,经VITEK2-Compact全自动细菌鉴定仪进行细菌鉴定和药敏试验,采用WHONET5.6软件对检测结果进行统计学分析。结果 呼吸机相关感染患者65例共培养病原菌101株,其中革兰阴性菌71株(70.30%),革兰阳性菌9株(8.91%),真菌21株(20.79%);在革兰阴性杆菌中,前3位的致病菌分别是鲍曼不动杆菌22株(21.78%)、铜绿假单胞菌20株(19.80%)、肺炎克雷伯菌12株(11.89%);9株革兰阳性菌都是金黄色葡萄球菌;药敏结果显示耐碳青霉烯的鲍曼不动杆菌(CRABA)的比率为95.20%,耐碳青霉烯的铜绿假单胞菌(CRPAE)为28.60%,耐甲氧西林的金黄色葡萄球菌(MRSA)为100.00%。结论 本院ICU危重症患者呼吸机相关感染的病原菌以革兰阴性菌为主,而MRSA、CRABA和CRPAE占的比率非常高,给临床治疗带来严峻的考验,需采取相应的措施遏制耐药菌的漫延。

Objective To investigate the distribution and drug resistance of pathogens isolated from the critical patients with ventilator-associated infections in ICU from our hospital.Methods 561 critically ill patients treated by mechanical ventilation from January,2016 to December,2017 in the ICU of our hospital were selected.65 sputum specimens from the patients with ventilator related infection were collected,and the bacteria were cultured and isolated.The bacterial identification and drug sensitivity test were carried out by VITEK 2-Compact automatic bacterial identification instrument,and the results were statistically analyzed by WHONET5.6.Results Among the 65 patients with ventilator-associated infection,101 strains of pathogenic bacteria were cultured.There were 71 strains of negative bacteria,accounting for 70.30%;9 strains of positive bacteria,accounting for 8.91%;and 21 strains of fungi,accounting for 20.79%.Among the gram-negative bacilli,the top three pathogenic bacteria were 22 strains of acinetobacter bauman,accounting for 21.78%;20 strains of pseudomonas aeruginosa,accounting for 19.80%;and 12 strains of klebsiella pneumoniae,accounting for 11.89%.The 9 strains of Gram-positive bacteria were staphylococcus aureus.The drug sensitivity results showed that the proportion of carbapenem resistant acinetobacter bauman(CRABA)was 95.2%,the proportion of carbapenem resistant pseudomonas aeruginosa(CRPAE)was 28.6%,and the proportion of methicillin resistant staphylococcus aureus(MRSA)was 100.0%.Conclusion The pathogenic bacteria associated with ventilator related infection in critically ill patients in the ICU in our hospital are mainly Gram-negative bacteria;the proportions of MRSA,CRABA,and CRPAE are very high,which brings severe test to clinical treatment.It is necessary to take corresponding countermeasures to control drug resistant bacteria.