ICU病房呼吸机相关性肺炎的病原菌及耐药状况研究  

A Study about the ICU Patients＇VAP Pathogenic Bacteria and Its Resistance to Drugs

作　　者：陈梅[1] 樊孝廉[1] 周金凤[1] 关幼华[1] 潘访谦[1] 黎仕斌[1] 丘新才[1] 黄克坚[1] 邓素莲[1] 张宗棉[1] 区洁芬[1] 

机构地区：[1]南方医科大学附属南海人民医院,广东佛山528200

出　　处：《国际医药卫生导报》2007年第17期81-86,共6页International Medicine and Health Guidance News

摘　　要：目的研究ICU病房呼吸机相关性肺炎（VAP）病原菌及其耐药状况,旨在减少抗生素的经验性用药和滥用,减少VAP发生,降低病死率。方法对2004年10月～2006年6月ICU病房机械通气患者气管深部痰液,支纤镜吸痰标本进行细菌学培养,药敏采用K-B法和梅里埃ATB药敏试条。结果131例患者中机械通气发生VAP62例,发生率47.3%,死亡率19.9%,病原菌以革兰氏阴性菌为主占60.6%（186/307）,其中嗜麦芽窄食单胞菌18.2%占据第一,革兰氏阳性球菌占25.1%（77/307）,真菌占14.3%（44/307）;药敏试验除嗜麦芽窄食单胞菌外,头胞他啶、头胞吡肟、美罗培南、哌拉西林/他唑巴坦耐药率在4%～30%之间,亚胺培南的耐药率0%,万古霉素耐药率0%,二者仍是ESBLs、MRS首选药物。结论ICU病房VAP病原菌以革兰氏阴性菌为主,其次为革兰氏阳性球菌及真菌感染,病原菌多重耐药性增加,特别是嗜麦芽窄食单胞菌感染上升给临床治疗带来的困难,应受到重视。Objective Study of the VAP pathogenic bacteria and its drug resistance in ICU, to decrease the antibiotic drug abuse, reduce the VAP incidence and death rate. Methods Spetum samples collected by bronchoscope from the deep trachea of the ventilator patients from 2004.10 to 2006.06 in ICU, all the samples received bacterial culture, the drug sensitive test adopts K-B method and bioM~ rieux ATB strip. Results 62 cases in all 131cases occurred VAP, the incidence was 47.3% and the death rate was 19.1%. The pathogenic bacteria gave priority to the gram-negative bacterium （60.6%）, and the main gram-negative bacterium was stenotrophomonas maltophilila （18.2%）; grampositive coccobacteria was 25.1%, and Fungus was 14.3%.The drug sensitive test showed that the drug resistance rate including the Ceftazidime, Cefepime, Meraopenem, Piperacillin/Tazobactam was from 4% to 30% （ except the stenotrophomonas maltophilila）, The drug resistance rate included the Imipenem and Vancomycin was 0%, they two were the first choice drugs to the ESBLS and MRS. Conclusion The main VAP pathogenic bacteria was gram-negative bacterium, gram-positive coccobacteria and fungus infection were secondary, The bacterium spectrum and multiple resistance to drugs were increasing, especially the increasing infectinon of stenotrophomonas maltophilia bring difficulty to clinical treatment and should pay attention to it.

关 键 词：呼吸机相关性肺炎 病原菌 耐药状况 

分 类 号：R4[医药卫生—临床医学] R563