重症监护室呼吸机相关性肺炎患者下呼吸道分泌物标本主要致病菌分布及耐药性

Distribution of Main Pathogenic Bacteria and Antimicrobial Resistance in Lower Respiratory Tract Secretions of Patients with Ventilator-Associated Pneumonia in Intensive Care Unit

目的探讨重症监护室呼吸机相关性肺炎(VAP)患者下呼吸道分泌物标本主要致病菌分布及对抗菌药物耐药性。方法选取2017年3月至2020年10月中国人民解放军联勤保障部队第九八八医院收治的153例重症监护室VAP患者作为研究对象,取其下呼吸道分泌物标本实施病菌培养、药敏试验。统计致病菌分布情况,同时分析主要致病菌的耐药性。结果153例重症监护室VAP患者中共分离出212株病原菌,其中42株(19.81%)革兰阳性菌,以表皮葡萄球菌、金黄色葡萄球菌为主,151株(71.23%)革兰阴性菌,以铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌为主,19株(8.96%)真菌。金黄色葡萄球菌、表皮葡萄球菌对青霉素G、阿莫西林、氨苄西林、阿奇霉素耐药性较高,均达到50.00%以上,对庆大霉素、亚胺培南耐药性较低,对利奈唑胺、万古霉素无耐药性;铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌对头孢吡肟、头孢他啶、头孢西丁、氨曲南、头孢曲松、左氧氟沙星耐药性较强,对亚胺培南、阿米卡星、头孢哌酮/舒巴坦耐药性较弱。结论重症监护室VAP患者下呼吸道分泌物标本中存在多种病原菌,以革兰阴性菌为主,且病原菌间耐药性不同,对下呼吸道分泌物标本实施病菌培养、药敏试验可为临床合理用药提供参考。

Objective To investigate the distribution of main pathogenic bacteria and antimicrobial resistance in the lower respiratory tract secretions of patients with ventilator-associated pneumonia(VAP)in Intensive Care Unit.Methods A total of 153 VAP patients in Intensive Care Unit in No.988 Hospital of the Joint Logistic Support Force of the People’s Liberation Army from March 2017 to October 2020 were selected as the research subjects.Bacteria culture and drug sensitivity test were carried out on the secretion samples of the lower respiratory tract.The distribution of pathogenic bacteria was statistically analyzed,and the drug resistance of main pathogenic bacteria was analyzed.Results A total of 212 strains of pathogenic bacteria were isolated from 153 VAP patients in Intensive Care Unit,among which 42 strains(19.81%)were Gram-positive bacteria,mainly Staphylococcus aureus and Staphylococcus epidermis,and 151 strains(71.23%)were Gram-negative bacteria,mainly Acinetobacter baumannii,Klebsiella pneumoniae,Pseudomonas aeruginosa and Escherichia coli.19 strains(8.96%)were fungi.Staphylococcus aureus and Staphylococcus epidermidis showed high resistance to penicillin G,amoxicillin,ampicillin and azithromycin,all of which reached more than 50.00%,and low resistance to gentamicin and imipenem,but no resistance to linezolid and vancomycin.Acinetobacter baumannii,Klebsiella pneumoniae,Pseudomonas aeruginosa and Escherichia coli showed strong resistance to cefepime,ceftriaxone,ceftazidime,cefoxitin,amtronam and levofloxacin,and weak resistance to amikacin,cefoperazone/sulbactam and imipenem.Conclusion There are a variety of pathogens in the lower respiratory tract secretions samples of VAP patients in Intensive Care Unit,mainly Gram-negative bacteria,and the drug resistance among the pathogens is different.Bacteria culture and drug sensitivity test for the lower respiratory tract secretions samples can provide reference for clinical rational drug use.