重症监护病房呼吸机相关性肺炎的病原菌及耐药性  

Pathogens Causing Ventilator-associated Pneumonia in ICU and Antimicrobial Resistance

作　　者：何晓雯[1,2] 曾一芹[2] 左江成[1,2] 王群兴[1,2] 周宜兰[2] 陈春燕[2] 

机构地区：[1]三峡大学第一临床医学院,湖北宜昌443003 [2]宜昌市中心人民医院检验科,湖北宜昌443003

出　　处：《中华医院感染学杂志》2008年第10期1441-1443,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨重症监护病房(ICU)呼吸机相关性肺炎(VAP)的病原菌及其耐药性,为临床诊断与治疗提供参考依据。方法对ICU VAP患者进行病案调查;并对患者的痰及下呼吸道分泌物进行常规细菌培养,用琼脂扩散法进行药物敏感试验并统计分析。结果ICU 184例VAP患者均患有严重的基础疾病;机械通气的插管方式为经口气管插管、经鼻气管插管和气管切开等;VAP病原菌以G-菌为主占79.9%,其中铜绿假单胞菌41株,居首位占22.3%;肺炎克雷伯菌30株,居第2占16.3%;G+菌中耐甲氧西林金黄色葡萄球菌(MRSA)12株,占总株数的6.5%;耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)5株,占2.7%;耐药监测结果显示,G-菌均出现较强的耐药性。结论加强对VAP病原菌的监测与控制,才能提高VAP的诊断与治疗水平。OBJECTIVE To explore pathogens causing ventilator-associated pneumonia （VAP） in intensive care unit （ICU） and their drug-resistance and to provide the reference for clinical diagnoses and treatments. METHODS The cases of VAP in ICU were investigated. The sputa and secretions of lower respiratory tract were investigated by the routine bacterial culture methods and drug-resistance was analyzed by agar diffusion methods. RESULTS Totally 184 patients with VAP had severe underlying diseases. The tracheal intubations were through mouth, nose or incision of trachea. The majority of pathogens was Gram-negative bacteria （79. 9%） in which Pseudo- monas aeruginosa was rated as the top one （22.3%）, and the next one was Klebsiella pneumoniae （16. 3%）. Twelve strains of MRSA counted for 6.5% in Gram-positive bacteria. 5 strains of MRCNS contributed to 2.7%. The result of the antibiotic resistance monitoring indicated that Gram-negative bacteria all showed higher drugresistance to common antibiotics. CONCLUSIONS We must strengthen monitoring and controlling on VAP to improve the clinical diagnoses and treatments.

关 键 词：重症监护病房 呼吸机相关性肺炎 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]