呼吸机相关性肺炎患者病原体检出分布特点及耐药性分析

Distribution characteristics and drug resistance of pathogens in patients with ventilator associated pneumonia

目的探讨该院呼吸机相关性肺炎(VAP)患者病原体检出分布特点及其耐药特征,为临床合理使用抗菌药物提供依据。方法回顾性分析该院2017年1月至2018年6月ICU58例VAP患者下呼吸道标本病原体检出分布及药物敏感性分析。结果从ICU58例呼吸机相关性肺炎患者中分离病原体74株,以革兰阴性杆菌检出为主(65/74),占比87.84%,且呈多重耐药性。其中肠杆菌科细菌占比36.92%(24/65),对哌拉西林、头孢曲松的耐药率在68%以上,对大部分临床常用抗菌药物的耐药率在55%以下;非发酵菌科细菌占比63.08%(41/65),对氨曲南、哌拉西林、头孢曲松的耐药率在77%以上,对阿米卡星、左氧氟沙星、亚胺培南表现出较好的敏感性;革兰阳性球菌占比12.16%,全部为金黄色葡萄球菌,对临床常用抗菌药物均表现比较敏感,常用抗菌药物的耐药率在40%以下。结论VAP患者检出病原体以革兰阴性杆菌为主,且呈多重耐药性,临床治疗困难,应加强VAP患者防控措施的落实,缩短机械通气天数,合理使用抗菌药物,延缓耐药菌株的产生。

Objective To investigate the distribution and drug resistance of pathogens in patients with ventilator-associated pneumonia in our hospital,Provide the basis for rational use of antimicrobial agents.Methods Analyze retrospectively the distribution and drug sensitivity analysis of the pathogens of the lower respiratory tract specimens of 58 patients with ICU-VAP from January 2017 to June 2018 in our hospital.Results 74 strains of pathogens were isolated from 58 patients with ventilator associated pneumonia in ICU,dominated by Gram negative bacillus(65/74,87.84%),and showed multi drug resistance.among them,The proportion of enterobacteriaceae bacteria is 36.92%(24/65),The drug resistance rate of piperacillin and ceftriaxone is more than 68%,The resistance rate of most commonly used antibiotics is below 55%;The proportion of non-fermented bacteria is 63.08%(41/65),The drug resistance rate of Aztreonam,piperacillin and ceftriaxone is more than 77%,It showed better sensitivity to Amikacin,levofloxacin and imipenem;The proportion of Gram positive coccus is 12.16%(9/74),all of them were Staphylococcus aureus,It is sensitive to most of clinical antibiotics.The drug resistance rate is less than 40%.Conclusion The pathogens in VAP patients were mainly Gram negative bacillus,and showed multi drug resistance,difficulty in clinical treatment,strengthen the implementation of VAP prevention and control measures,Shorten mechanical ventilation days,and use antimicrobials agents rationally,delay the emergence of resistant strains.