冠脉搭桥术后呼吸机相关性肺炎病原学及耐药性分析  

Distribution and Drug-resistance of Pathogens in Patients with Ventilator-associated Pneumonia after Coronary Artery Bypass Graft

作　　者：安向光[1] 曹建伟[1] 刘岩[1] 顾松[1] 张希涛[1] 苏丕雄[1] 

机构地区：[1]首都医科大学附属北京朝阳医院心脏中心心外ICU,北京100020

出　　处：《中华医院感染学杂志》2009年第19期2626-2628,共3页Chinese Journal of Nosocomiology

摘　　要：目的分析冠脉搭桥术后呼吸机相关性肺炎的病原学构成和耐药情况,为临床合理使用抗菌药物提供依据。方法对39例接受机械通气并发呼吸机相关性肺炎患者的下呼吸道分泌物中的病原菌及药敏结果进行分析。结果检出病原菌166株,其中G-菌141株(84.94%),G+菌13株(7.83%),真菌12株(7.23%);前4位病原菌分别为铜绿假单胞菌68株(40.96%),不动杆菌属25株(15.06%),嗜麦芽寡养单胞菌21株(12.65%),伯克霍尔德菌属14株(8.43%);铜绿假单胞菌对头孢吡肟最为敏感,不动杆菌属及伯克霍尔德菌属对亚胺培南最为敏感,嗜麦芽寡养单胞菌对复方新诺明最为敏感,葡萄球菌属对万古霉素最为敏感,上述菌株多药耐药现象严重。结论冠脉搭桥术后呼吸机相关性肺炎的病原菌以G-菌为主,其药敏试验呈现多药耐药,混合感染现象严重,临床应引起足够重视,开展细菌耐药监测并合理使用抗菌药物。OBJECTIVE To analyze the distribution and drug-resistance of pathogens in patients with ventilator-associated pneumonia （VAP） following coronary artery bypass graft, and to provide the rational antibiotic strategies. METHODS The pathogens and the drug resistance of VAP in 39 patients receiving mechanical ventilation in cardiosurgical（CSICU） were investigated. RESULTS All 166 strains pathogens were isolated by bacterial culture. From them 141 strains （84.94%） were Gram-negative bacteria, 13 strains （7.83%） were Gram- positive bacteria, and 12 strains （7.23%） were the fungi. Among pathogens the most common were Pseudomonas aeruginosa （68 strains）, Acinebacter （25 strains）, Stenotrophomonas maltophilia（21 strains）, Burkholderia（14 strains）. Imipenem cilastatin sodium was the most sensitive drug for Acinebacter and Burkholderia. Cefepime was the most for P. aeruginosa. Trimethoprim/sulfamethoxazole was the most for S. maltophilia. And vancomycin hydrochloride was the most for S. aureus. Their multi drug-resistance to antimicrobial agents was serious. CONCLUSIONS Gram-negative bacteria are the majority of the pathogens from patients receiving mechanical ventilation with VAP after coronary artery bypass graft. The pathogens are multidrug-resistant in drug sensitive test. It is suggested that there be urgent need for surveillance of bacterial resistance and rational use of antimicrobial agents during the clinical therapy.

关 键 词：冠脉搭桥术后 呼吸机相关性肺炎 病原菌 药敏试验 

分 类 号：R378[医药卫生—病原生物学]