综合ICU内外科患者呼吸机相关性肺炎的病原学分析  

Analysis of pathogens between medical and surgical patients with ventilator-associated pneumonia(VAP) in general ICU

作　　者：王家赐[1] 李锦山[1] 刘八一[1] 

机构地区：[1]广东省中山市中医院,528400

出　　处：《首都公共卫生》2012年第1期21-24,共4页Capital Journal of Public Health

摘　　要：目的探讨综合重症监护病房(ICU)内外科患者呼吸机相关性肺炎(VAP)病原菌的种类分布、耐药情况。方法对2008～2010年中山市中医院综合ICU内科及外科患者VAP病原菌种类分布及耐药性进行统计分析。结果从136例VAP患者支气管分泌物中分离出病原菌共143株。内科患者分离菌株为91株(63.6%),其中革兰阴性细菌67株(46.9%),革兰阳性细菌19株(13.3%),真菌5株(3.5%);外科患者分离菌株为52株(36.4%),其中革兰阴性细菌39株(27.3%),革兰阳性细菌10株(7.0%),真菌3株(2.1%)。内外科患者铜绿假单胞菌、嗜麦芽窄食单胞菌和鲍曼不动杆菌3种革兰阴性菌株对头孢噻肟全耐药,对头孢吡肟、头孢哌酮耐药情况亦十分严重,外科患者菌株的耐药率相对比内科患者低,但无统计学意义(P>0.05)。内外科患者分离到的苯唑西林耐药金黄色葡萄球菌(MRSA)检出率分别为95.2%,94.1%;苯唑西林耐药溶血性葡萄球菌内外科患者检出率均为100%。结论该院ICU总体VAP病原菌中内科和外科患者均以革兰阴性细菌居多(74.1%),但内外科患者分离到的病原菌种类分布稍有不同,与多种因素相关;在耐药程度上,内外科患者间比较差异无统计学意义。Objective To investigate the distribution and drug resistance of pathogens between medical and surgical patients with ventilator-associated pneumonia （VAP） in general intensive care unit （ICU）. Methods Statistical methods were used to analyze the data of pathogens and drug resistance of medical and surgical patients with VAP in our general ICU from 2008 to 2010. Results We separated 143 strains of pathogens from the bronchial secretions of 136 VAP patients. 91 strains of pathogens （63.6 % ） were separated from medical patients including 67 Gram-negative bacteria （46. 9% ）, 19 Gram-positive bacteria （ 13.3% ） and 5 fungi （3.5%）. 52 strains of pathogens （63.6 % ） were separated from surgical patients including 39 Gram-negative bacteria （27.3%）, 10 Gram-positive bacteria （7.0%） and 3 fungi （2.1%）. All the Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Acinetobacter baumannii in medical and surgical patients, were resistant to cefotaxime completely, to cefepime and cefoperazone seriously. Although the rate of drug-resistant in surgical patient was lower than in medical patient, there was no statistical significance （P 〉 0.05）. The detective rate of methicillin-resistant Staphylococcus aureus （MRSA） in medical patients and surgical patients was 95.2% and 94.1% respectively. The detective rate of MRSA in medical patients was 100% , the same with surgical patients. Conclusion Gram-positive bacteria were the major pathogen for VAP patients in the general ICU of our hospital. The proportion was about 74.1%. Relative to many different factors, the distribution for the types of pathogen, which separated from medical patients and surgical patients, was different. The level of resistance was no significant difference between medical patients and surgical patients.

关 键 词：呼吸机相关性肺炎 重症监护病房 内外科病原菌分布 耐药率 

分 类 号：R563.1[医药卫生—呼吸系统]