呼吸机相关性肺炎患者气囊上滞留物病原菌分布及耐药性分析  

Pathogenic Bacteria Isolated from Subglottic Secretion in 43 Cases with Ventilator-associated Pneumonia: Their Distribution and Drug Resistance

作　　者：王伟华[1] 郑逸华[1] 徐文芳[1] 

机构地区：[1]江山市人民医院ICU,浙江江山324100

出　　处：《中华医院感染学杂志》2009年第8期921-923,共3页Chinese Journal of Nosocomiology

基　　金：江山市科技局批准立项课题(060324)

摘　　要：目的研究呼吸机相关性肺炎(VAP)患者气囊上滞留物病原菌分布并进行耐药性分析,指导临床合理使用抗菌药物,防治VAP。方法将43例VAP患者气囊上滞留物进行引流,并将气囊上滞留物与下呼吸道分泌物分离出的339株病原菌进行鉴定和耐药分析,并进行对比分析。结果43例VAP患者气囊上液分离出201株病原菌,其中革兰阴性杆菌166株,占82.6%,主要优势菌为鲍氏不动杆菌、铜绿假单胞菌、嗜麦芽寡养单胞菌、肺炎克雷伯菌,革兰阳性菌26株,占12.9%,主要为金黄葡萄球菌、表皮葡萄球菌,真菌9株,占4.5%;不同病原菌对抗菌药物多药耐药率均较高,但不同抗菌药物耐药率差异较大;下呼吸道分泌物共分离出138株病原菌,两者主要病原菌分布、构成比及耐药情况差异无统计学意义(P>0.05)。结论VAP气囊上滞留物病原菌分布革兰阴性杆菌为主,均存在多药耐药,气囊上液与下呼吸道分泌物病原菌株菌种的一致性且构成比及耐药性类似。OBJECTIVE To study the distribution of pathogenic bacteria isolated from subglottic secretion in ventilator-associated pneumonia （VAP） and analyze the drug resistance thereof to guide rational use of antibiotics in clinic and prevent VAP. METHODS Totally 339 strains of pathogenic bacteria isolated from subglottic secretions and lower respiratory tract secretions in 43 VAP patients were identified and their drug resistance was compared. RESULTS The distribution of a total of 201 strains of pathogenic bacteria from subglottic secretions in 43 VAP patients was that 166 strains were Gram-negative rods （82.6%）, the dominant bacteria were Acinetobacter baurnannii , Pseudornonas aeruginosa , Stenotrophornonas maltophiliaand Klebsiella pneumoniae ; 26 strains were Gram-positive cocci （12.9%）, the mian pathogens were Staphylococcus aureusand S. epiderrnidis; and 9 strains were fungi （4. 5%）. The drug sensitivity test results indicated that the pathogenic bacteria had a high rate of multi-drug resistance against antibiotics, but exhibited discrepant drug resistance rates in different antibiotics. A total of 138 strains of pathogenic bacteria were isolated from lower respiratory tract secretions. No statistical significance was observed between these two sources in terms of the distribution, composition and drug resistance of major pathogenic bacteria （P〉0.05）. CONCLUSIONS The pathogenic bacteria from VAP subglottic secretion are mostly Gram-negative rods, in which the dominant bacteria are A. baumannii, P. aeruginosa, S. maltophilia, K. pneurnoniae and Escherichia coli. Most of them are multi-drug resistant. The kinds of pathogenic bacterial strains in subglottic secretion and lower respiratory tract secretion are not only consistent but also similar to each other in terms of composition and drug resistance.

关 键 词：气囊上滞留物 呼吸机相关性肺炎 耐药率 

分 类 号：R378[医药卫生—病原生物学]