呼吸机相关性肺炎致病微生物种类及耐药性分析

Distribution and drug resistance of pathogenic microorganisms in ventilator-associated pneumonia

目的分析医院获得性呼吸机相关性肺炎患者的致病微生物的种类及耐药性。方法选取新疆军区总医院2017年3月—2019年6月期间228例医院获得性呼吸机相关性肺炎患者作为研究对象,采用全自动微生物鉴定仪对下呼吸道痰液样本进行细菌鉴定,用纸片扩散法进行药敏试验。结果从228例患者的228份痰液样本中分离出279株致病微生物。主要革兰阴性菌为鲍曼不动杆菌(53株,19.00%)、铜绿假单胞菌(42株,15.05%)和嗜麦芽窄食假单胞菌(39株,13.98%);主要革兰阳性菌为金黄色葡萄球菌(19株,6.81%);主要真菌为白色假丝酵母菌(29株,10.39%)。鲍曼不动杆菌对亚胺培南、妥布霉素、米诺环素、美罗培南、阿米卡星的耐药率较低,均<20%;铜绿假单胞菌对亚胺培南、妥布霉素、米诺环素、阿米卡星的耐药率较低,均<10%;嗜麦芽窄食假单胞菌对20种抗菌药物的耐药性均>20%;金黄色葡萄球菌对亚胺培南、美罗培南、氯霉素、链霉素、利奈唑酮、利福平、阿米卡星的耐药率较低,<20%;白色假丝酵母菌对6种药物的耐药性均较低,<10%。结论鲍曼不动杆菌、铜绿假单胞菌和嗜麦芽窄食假单胞菌为医院获得性呼吸机相关性肺炎的主要致病菌,不同菌株的耐药性不同。

Objective To investigate the distribution and drug resistance of pathogenic microorganisms of hospital acquired ventilator-associated pneumonia patients.Methods From March 2017 to June 2019,228 patients who had acquired ventilator-associated pneumonia in General Hospital of Xinjiang Military Command were selected as the research object.The pathogenic microorganisms were identified by automatic microbial identification instrument.The drug sensitivity test was carried out by the disk diffusion method.Results A total of 279 pathogenic microorganisms were isolated from 228 samples of 228 patients.The main Gram-negative bacteria were Acinetobacter baumannii(53 strains,19.00%),Pseudomonas aeruginosa(42 strains,15.05%)and Stenotrophomonas maltophilia(39 strains,13.98%),the main Gram-positive bacteria was Staphylococcus aureus(19 strains,6.81%),the main fungi was Candida albicans(29 strains,10.39%).Acinetobacter baumannii had a low resistance rate to imipenem,tobramycin,minocycline,meropenem,and amikacin,all belowed 20%.The resistance rate of Pseudomonas aeruginosa to imipenem,tobramycin,minocycline and amikacin was lower,all belowed 10%.The resistance of Stenotrophomonas maltophilia to 20 antibiotic in this study was>20%.Staphylococcus aureus was less resistant to imipenem,meropenem,chloramphenicol,streptomycin,linezolid,rifampicin,and amikacin,<20%.Candida albicans was less resistant to 6 drugs,<10%.Conclusion Acinetobacter baumannii,Pseudomonas aeruginosa and Stenotrophomonas maltophilia were the main pathogenic bacteria in hospital-acquired ventilator-associated pneumonia.Drug resistance characteristics of different strains were also obviously different.