重症监护病房2002-2007年呼吸机相关性肺炎病原菌流行分布和耐药监测  

Epidemic Distribution of Pathogen and Drug Resistance Surveillance for Ventilator Associated Pneumonia in Intensive Care Unit between 2002 to 2007

作　　者：张国英[1] 王献民[1] 何伟[1] 郑静[1] 王晓蕾[1] 廖霓[1] 

机构地区：[1]成都市儿童医院ICU,成都610017

出　　处：《实用儿科临床杂志》2009年第4期264-267,共4页Journal of Applied Clinical Pediatrics

基　　金：四川省卫生厅科研课题项目资助(060180);成都市卫生局学术和技术带头人及培养对象培养资金项目资助(2006-61)

摘　　要：目的探讨成都市儿童医院ICU呼吸机相关性肺炎(VAP)的病原菌分布和耐药趋势的变化规律。方法对本院2002年1月-2007年12月ICU病房收治的机械通气>48 h的326例患儿中发生VAP的182例进行痰培养,对病原学及抗菌药物敏感性结果进行分析。呼吸机通气48 h后,采用一次性吸痰管经气管插管管道从下呼吸道采集分泌物标本立即送检。标本均按标准微生物学方法进行定量、定性培养。连续2次培养,同一优势菌株为致病菌;并对鉴定所用试剂及药敏分析所用抗菌药物纸片进行质量控制。结果机械通气326例患儿中182例发生VAP,其中2002-2004年48例,2005-2007年134例。共分离出病原菌235株,其中G-杆菌196株(83.4%)、G+球菌31株(13.2%)、真菌8株(3.4%)。本组病原菌中前10位依次为肺炎克雷伯杆菌36株(15.32%)、大肠埃希菌30株(12.77%)、阴沟肠杆菌26株(11.06%)、铜绿假单胞菌23株(9.79%)、不动杆菌20株(8.51%)、产气杆菌18株(7.66%)、表皮葡萄球菌17株(7.49%)、黏质沙雷菌15株(6.38%)、嗜麦芽假单胞菌13株(5.53%)、金黄色葡萄球菌12株(5.11%)。占G-杆菌构成比前5位的病原菌对亚胺培南、阿米卡星、哌拉西林/他唑巴坦较为敏感,而耐药率最高的药物为阿莫西林、氨苄西林、多种头孢菌素。2005-2007年金黄色葡萄球菌对青霉素、红霉素严重耐药,但对万古霉素、喹诺酮、阿奇霉素敏感性高。除铜绿假单胞菌、鲍曼不动杆菌外,未发现耐亚胺培南的G-杆菌菌株;耐甲氧西林金黄色葡萄球菌、耐甲氧西林凝固酶阴性的葡萄球菌、肺炎克雷伯杆菌及大肠埃希菌产超广谱β-内酰胺酶菌株检出率较2002-2004年明显上升。结论2005-2007年与2002-2004年相比,本院ICU中VAP发生率有增加趋势,常见病原菌耐药趋势呈多态性变化。及时监测ICU病原菌耐药趋势变化对指导危重患儿合理用药至关重要。Objective To explore the epidemic distribution of pathogens and tendency of drug resistance surveillance in ventilator associated pneumonia（VAP） in intensive care unit （ICU）of Chengdu children＇s hospital. Methods Pathogens were analyzed and the antibiotics sensitivity were determined in 326 children with mechanical ventilation over 48 hours in ICU of Chengdu children＇s hospital in Jan. 2002 to Dec. 2007. After mechanical ventilation over 48 hours, specimen was collected from lower respiratory tract through cndotracheal intubation tube with one - time suction tube and inspected at once. All specimen were cultured qualitatively and quantitatively in accordance with the standard method of microbiology and in continous 2 times, and the same advantages were regarded the strains of pathogens. Quality was controlled to all of reagents and antibiotics paper. Results One hundred and eighty - two cases of 326 cases with mechanical ventilation occured VAP, which 48 cases in 2002 -2004,134 cases in 2005 -2007 ;235 strain bacteria were isolated, among the total, 196 strain gram - negative bacteria （83.4%） ,31 strain gram - positive bacteria（ 13.2% ） ,8 strain eumycete（3.4% ）. The sequence of 10 leading pathogen were 36 strain klebsiella pneumonia（ 15.32% ） ,30 strain escherichia eoli（ 12.77% ） ,26 strain enterobacter cloacae （ 11.06% ） ,23 strain pseudomonas aeruginosa（9.79% ） ,20 strain acinetobaeter（ 8. 51% ） ,18 strain aerobaeter aerogenes（7.66% ） , 17 strain staphylococcus epidermidis （7.49%） , 15 strain serratia marcescens （6.38%） , 13 strain pseudomonas mahophilia （ 5.53% ） , 12 strain staphylococcus aureus （5. 11% ）. The top 5 bacteria in the proportion of gram - positive bacteria were more sensitive to ilnipenem, amikacin sulfate and piperaeillin/tazobactam, but were resistant to amoxicillin,ampieillin and cefazolins. Staphylococci was serious resistant to penicillin and erythromyein,but was more sensitive to vaneomyein, quinolone and azithromycin. Except

关 键 词：重症监护病房 呼吸机相关性肺炎 病原菌 耐药 抗生素 

分 类 号：R446.5[医药卫生—诊断学]