重症监护室老年呼吸机相关性肺炎患者病原菌分布及耐药性分析

Analysis of Pathogenic Bacteria Distribution and Drug Resistance in Elderly Patients with Ventilator-associated Pneumonia in Intensive Care Unit

目的:分析周口市中医院重症监护室老年呼吸机相关性肺炎(VAP)患者的病原菌分布及耐药性。方法:选取2020年2月至2023年2月期间周口市中医院重症监护室收治的86例老年VAP患者作为研究对象,采集患者下呼吸道分泌物标本,进行病原菌检测与药敏试验,分析病原菌分布情况及其药物敏感性。结果:本研究86例老年VAP患者痰培养中分离、培养出病原菌共计119株,其中真菌共计21株,占比17.65%;革兰阳性菌共计17株,占比14.29%;革兰阴性菌共计81株,占比68.07%。革兰阴性菌对头孢曲松、左氧氟沙星、美罗培南、头孢唑林等药物的耐药性较高,对妥布霉素、阿米卡星、亚胺培南等药物的耐药性较低;革兰阳性菌对复方新诺明、庆大霉素、环丙沙星、红霉素、青霉素等耐药性较高,对左氧氟沙星、头孢西丁、万古霉素耐药性较低。结论:周口市中医院重症监护室老年VAP患者主要致病菌为铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌等,在临床治疗时应根据致病菌分布特点及药物耐受情况给予针对性用药。

Objective To analyze the distribution and drug resistance of pathogenic bacteria in elderly patients with ventilatorsassociated pneumonia(VAP)in the intensive care unit of Zhoukou Hospital of Traditional Chinese Medicine.Methods A total of 86 elderly VAP patients admitted to the Intensive care Unit of Zhoukou Hospital of Traditional Chinese Medicine from February 2020 to February 2023 were selected as research objects.Secretion samples of lower respiratory tract of patients were collected for pathogen detection and drug sensitivity test,and the distribution of pathogenic bacteria and drug sensitivity were analyzed.Results In this study,a total of 119 strains of pathogenic bacteria were isolated and cultured in sputum culture of 86 elderly VAP patients,including 21 strains of fungi,accounting for 17.65%.There were 17 strains of gram-positive bacteria,accounting for 14.29%.Gram-negative bacteria accounted for 81 strains,accounting for 68.07%.The resistance of gram-negative bacteria to ceftriaxone,levofloxacin,meropenem and cefazolin was high,while the resistance to tobramycin,amicacin and imipenem was low.The resistance of gram-positive bacteria to cotrimoxazole,gentamicin,ciprofloxacin,erythromycin and penicillin was high,and the resistance to levofloxacin,cefoxitin and vancomycin was low.Conclusion The main pathogenic bacteria of elderly VAP patients in the intensive care unit of Zhoukou Hospital of Traditional Chinese Medicine are Pseudomonas aeruginosa,Escherichia coli,Klebsiella pneumoniae,Staphylococcus aureus and Acinetobacter baumannii,etc.In clinical treatment,targeted drugs should be given according to the distribution characteristics of pathogenic bacteria and drug tolerance.