呼吸机相关性肺炎常见致病菌耐药性分析和预防  

Common Pathogens of Vent-associated Pneumonia and Their Drug Resistance in ICU

作　　者：叶初阳[1] 杨日焰[1] 刘延媛[1] 石喆[1] 

机构地区：[1]广东省惠州市中心人民医院ICU,广东惠州516000

出　　处：《航空航天医药》2010年第6期879-881,共3页Aerospace Medicine

摘　　要：目的:分析医院综合ICU呼吸机相关性肺炎的病原菌分布及其耐药性,为呼吸机相关性肺炎的预防及治疗提供参考。方法:回顾分析109例呼吸机相关性肺炎患者的病原菌谱、耐药性及其临床特征。结果:VAP平均发病时间为机械通气后6.3d,总病死率为46.8%,共分离出病原菌192株,其中革兰阴性菌138株(占71.9%),革兰阳性菌39株(占20.3%),真菌15株(占7.8%)。革兰阴性菌中占前4位的分别是铜绿假单胞菌、不动杆菌属、肺炎克雷伯菌、大肠埃希菌,革兰阳性菌主要是金黄色葡萄球菌和凝固酶阴性葡萄球菌,其中耐甲氧西林的金黄色葡萄球菌对万古霉素有100%的敏感性。结论:呼吸机相关性肺炎的主要病原菌为革兰阴性杆菌,常为多重耐药的致病菌,积极治疗基础疾病、缩短机械通气时间、合理运用抗生素,以及做好各项预防消毒措施是防治VAP的关键。Objective：To investigate the pathogen distribution and antimicrobial resistance in ventilator-associated pneumonia（VAP） in intensive care unit（ICU） of our hospital and provide reference for clinical treatment.Methods：The bacterial spectrum from 109 patients in ICU from January 2007 to December 2009,the bacterial resistance to drugs and their clinical characteristics were analyzed retrospectively.Results：The average onset time of VAP was 6.3 days after mechanical ventilation with a mortality rate of 46.8%.A total of 102 strains of pathogens were identified of which 138（71.9%） were Gramnegative bacteria,39（20.3%） Grampositive cocci and 15（7.8%） fungi.The top 4 Gramnegative bacteria were Pseudomonasaeruginosa,Acinetobacter,Klebsiella pneumoniae,and Escherichia coli.The main Grampositive cocci were Staphyloccus aurens of which meticillin resistant S.aurens was 100% sensitive to vancomyc.Conclusions：VAP pathogens are mainly Gramnegative bacteria and have multiple resistance to drugs.Control and prevention strategies based on treatment of primary disease,shortening MV duration,rational use of antibiotic and sterilization should be encouraged to minimize morbimortality of the infection.

关 键 词：呼吸机相关性肺炎 细菌 药物耐受 抗生素类 预防 

分 类 号：R563.1[医药卫生—呼吸系统]