重症监护病房呼吸机相关肺炎病原学分析及临床研究  

Pathogenic analysis and clinical research of ventilator-associated pneumonia in patients in ICU

作　　者：李毅[1] 冯强[1] 刘树延[1] 

机构地区：[1]泰安市中心医院,山东泰安271000

出　　处：《中国感染控制杂志》2005年第1期55-57,共3页Chinese Journal of Infection Control

摘　　要：目的　研究医院重症监护病房 (ICU)呼吸机相关肺炎 (VentilatorAssociatedPneumonia ,VAP)病原菌的分布及耐药特点 ,指导临床合理用药。方法　分析某院ICU病房 2 0 0 2年 2月～ 2 0 0 3年 8月发生VAP患者的临床特征、病原菌谱及耐药性。结果　 4 2例VAP患者共检出 5 8株病原菌 ,革兰阴性 (G-)杆菌占 79.31% ,革兰阳性(G+ )球菌占 13.79% ,真菌占 6 .90 % ;G-杆菌以铜绿假单胞菌 (30 .95 % )为多 ,G+ 球菌主要为金黄色葡萄球菌(75 .0 0 % ) ,耐甲氧西林金黄色葡萄球菌 (MRSA)占金黄色葡萄球菌的 5 0 %。G-杆菌对阿米卡星、哌拉西林 /舒巴坦、头孢他啶、亚胺培南较敏感 ;产ESBLs菌对亚胺培南 ,MRSA对万古霉素均 10 0 %敏感。结论　ICU病房VAP病原菌以G-杆菌为主 ,耐药率高 ,临床医师应根据药敏试验合理选择抗菌药物。Objective To study the distribution of bacteria causing ventilator-associated pneumonia (VAP) and characteristics of antimicrobial resistance in ICU, and to provide guidance for the rational antimicrobial use in clinic. Methods Clinical characteristics, bacteria causing VAP and antimicrobial resistance during February 2002～August 2003 were analysed. Results Among 58 strains isolated from 42 cases with VAP, the percentage of gram-negative bacilli, gram-positive cocci and fungi was 79.31%, 13.79% and 6.90%, respectively. Pseudomonas aeruginosa was the major isolated bacteria among gram-negative strains ( 30.95%), Staphylococcus aureus was the most common isolated bacteria among gram-positive strains ( 75.00%), and MRSA accounted for 50%. Gram-negative bacteria were sensitive to amikacin, piperacillin/sulbactam, ceftazidime and imipenem. The sensitive rates of ESBL-producing strains to imipenem and MRSA to vancomycin were all 100%. Conclusion Gram-negative bacteria are the main pathogens causing VAP in patients in ICU, and bacteria strains have high antimicrobial resistance, clinicians should choose antimicrobial agents according to antimicrobial susceptibility test result.

关 键 词：呼吸机相关肺炎 医院感染 病原菌 革兰阴性细菌 微生物敏感性试验 

分 类 号：R181.32[医药卫生—流行病学]