呼吸机相关性肺炎患者下呼吸道分泌物分离菌的分布特征及耐药谱分析

Distribution characteristics and drug resistance spectrum of isolates of lower respiratory tract secretions in patients with ventilator-associated pneumonia

目的:分析呼吸机相关性肺炎(VAP)患者下呼吸道分泌物分离菌的分布特征及耐药谱。方法:回顾性分析周口市中心医院2017年10月至2019年10月152例VAP患者下呼吸道分泌物的细菌培养与药敏试验结果,分析分离菌分布特征及耐药谱。结果:152例VAP患者下呼吸道分泌物分离菌共247株,包括革兰阴性菌188株(76.11%),革兰阳性菌41株(16.60%)及真菌18株(7.29%),感染病原菌以肺炎克雷伯菌(25.91%)、铜绿假单胞菌(20.24%)、大肠埃希菌(12.96%)、金黄色葡萄球菌(9.31%)、鲍式不动杆菌(7.29%)最为常见;主要革兰阴性菌中肺炎克雷伯菌对氨苄西林(100.00%)、哌拉西林(60.94%)、环丙沙星(60.94%)耐药率高,对阿米卡星(9.38%)、哌拉西林/他唑巴坦(15.63%)敏感;铜绿假单胞菌对氨苄西林(100.00%)、复方新诺明(100.00%)耐药率高,对多粘菌素B、哌拉西林/他唑巴坦(8.00%)、妥布霉素(10.00%)敏感;大肠埃希菌对氨苄西林(100.00%)、哌拉西林(90.63%)耐药率较高,对亚胺培南、美罗培南、阿米卡星敏感;鲍曼不动杆菌对氨苄西林(100.00%)、头孢他啶(94.44%)、哌拉西林(88.89%)、哌拉西林/他唑巴坦(88.89%)、美罗培南(83.33%)耐药率较高,对多粘菌素B敏感;主要革兰阳性菌中金黄色葡萄球菌对青霉素(100.00%)、环丙沙星(82.61%)耐药率较高,表皮葡萄球菌对青霉素(10.00%)、头孢唑林(86.67%)、克林霉素(86.67%)、庆大霉素(86.67%)耐药率高,两种病原菌对万古霉素、替考拉宁均敏感。结论:VAP患者下呼吸道分泌物分离菌以革兰阴性菌为主,主要为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌,主要分离菌耐药情况较严重,临床应对针对病原菌耐药谱合理应用抗菌药,避免滥用抗菌药。

Objective To analyze the distribution characteristics and drug resistance spectrum of isolates of lower respiratory tract secretions in patients with ventilator-associated pneumonia(VAP).Methods A retrospective analysis was performed on results of bacterial culture and drug sensitivity test of lower respiratory tract secretions of 152 cases of VAP patients in Zhoukou Central Hospital from October 2017 to October 2019,and the distribution characteristics and drug resistance spectrum of isolates were analyzed.Results There were 247 isolates in lower respiratory tract secretions of 152 VAP patients,including 188 strains of Gram-negative bacteria(76.11%),41 strains of Gram-positive bacteria(16.60%)and 18 strains of fungi(7.29%).The most common infection pathogens were Klebsiella pneumoniae(25.91%),Pseudomonas aeruginosa(20.24%),Escherichia coli(12.96%),Staphylococcus aureus(9.31%),and Acinetobacter baumannii(7.29%).The main Gram-negative bacteria of Klebsiella pneumoniae had a high resistance rate to Ampicillin(100.00%),Piperacillin(60.94%)and Ciprofloxacin(60.94%),and it was sensitive to Amikacin(9.38%)and Piperacillin/Tazobactam(15.63%).Pseudomonas aeruginosa had a high resistance rate to Ampicillin(100.00%)and Compound sulfamethoxazole(100.00%),and it was sensitive to Polymyxin B,Piperacillin-tazobactam(8.00%)and Tobramycin(10.00%).Escherichia coli had a high resistance rate to Ampicillin(100.00%)and Piperacillin(90.63%),and it was sensitive to Imipenem,Meropenem and Amikacin.Acinetobacter baumannii had a high resistance rate to Ampicillin(100.00%),Ceftazidime(94.44%),Piperacillin(88.89%),Piperacillin/Tazobactam(88.89%)and Meropenem(83.33%),and it was sensitive to Polymyxin B.The main Gram-positive bacteria of Staphylococcus aureus had a high resistance rate to Penicillin(100.00%)and Ciprofloxacin(82.61%),and Staphylococcus epidermidis had a high resistance rate to Penicillin(10.00%),Cefazolin(86.67%),Clindamycin(86.67%),and Gentamicin(86.67%).Both pathogens were sensitive to Vancomycin and Teicoplanin.Conclusions The isolates of lower respiratory tract secretions of VAP patients are mainly Gram-negative bacteria,mainly Klebsiella pneumoniae,Pseudomonas aeruginosa,and Escherichia coli.The main isolates are more resistant,and clinically,it is necessary to reasonably apply antimicrobial drugs based on the drug resistance spectrum of pathogens so as to avoid abuse of antimicrobial drugs.