革兰阴性杆菌感染呼吸机相关性肺炎患者病原菌分布及耐药性

Pathogenic bacteria distribution and drug resistance in patients with ventilator-associated pneumonia caused by Gram-negative bacilli

目的:分析革兰阴性杆菌感染呼吸机相关性肺炎(VAP)患者病原菌分布及耐药性。方法:选取2020年3月至2022年12月该院收治的134例革兰阴性杆菌感染VAP患者进行前瞻性研究。采集患者下呼吸道分泌物标本,分析革兰阴性杆菌分布及耐药性。结果:134例革兰阴性杆菌感染VAP患者下呼吸道分泌物中检出347株病原菌,其中铜绿假单胞菌检出率最高(101株,29.11%),其次为肺炎克雷伯菌(62株,17.87%)、大肠埃希菌(52株,14.99%)、鲍曼不动杆菌(49株,14.12%);肺炎克雷伯菌对阿米卡星、哌拉西林/他唑巴坦、头孢替坦的耐药性为80%以上;鲍曼不动杆菌对左氧氟沙星、氨苄西林/舒巴坦、氨苄西林的耐药性为70%以上;铜绿假单胞菌对阿米卡星的耐药性为81.19%;大肠埃希菌对亚胺培南、美罗培南的敏感性达100.00%。结论:铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌为革兰阴性杆菌感染VAP患者常见病原菌,其耐药性均较高。

Objective:To analyze pathogenic bacteria distribution and drug resistance in patients with ventilator-associated pneumonia(VAP)caused by Gram-negative bacilli.Methods:A prospective study was conducted on 134 patients with VAP caused by Gram-negative bacilli admitted to this hospital from March 2020 to December 2022.Lower respiratory tract secretion specimens were collected.The distribution and drug resistance of Gram-negative bacilli were analyzed.Results:347 strains of pathogenic bacteria were detected in the lower respiratory tract secretions of the 134 patients with VAP caused by Gram-negative bacilli.Among them,the detection rate of Pseudomonas aeruginosa was the highest(101 strains,29.11%),followed by Klebsiella pneumoniae(62 strains,17.87%),Escherichia coli(52 strains,14.99%),Acinetobacter baumannii(49 strains,14.12%).The resistance of Klebsiella pneumoniae to Amikacin,Piperacillin/Tazobactam and Cefotetan were more than 80%.The resistance of Acinetobacter baumannii to Levofloxacin,Ampicillin/Sulbactam and Ampicillin was more than 70%.The resistance of Pseudomonas aeruginosa to Amikacin was 81.19%.The sensitivity of Escherichia coli to Imipenem and Meropenem was 100.00%.Conclusions:Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli and Acinetobacter baumannii are common pathogens in the VAP patients cause by Gram-negative bacilli,and their drug resistance are high.