重症监护室呼吸机相关性肺炎的病原学分析  

An etiological analysis on ventilator-associated pneumonia in intensive care unit

作　　者：郑伟浩[1] 张丽珊[1] 伍国达 赵英萍[1] 

机构地区：[1]江门市中心医院重症医学科,529030 [2]微生物室

出　　处：《国际医药卫生导报》2012年第11期1607-1611,共5页International Medicine and Health Guidance News

摘　　要：目的了解重症监护室（ICU）呼吸机相关性肺炎（VAP）的病原菌分布及其耐药情况。方法对我院1CO2008年1月至2010年12月诊断为VAP的251例患者病原学资料进行回顾性分析。结果检出病原菌737株，其中革兰阴性菌（G-）346株（46．9％），主要为铜绿假单胞菌（113株）、肺炎克雷伯杆菌（58株）和鲍曼不动杆菌（57株）；革兰阳性菌（G＋）213株（28．9％），主要为金黄色葡萄球菌（91株，MRSA63株）、表皮葡萄球菌（45株）和溶血葡萄球菌（42株）；真菌178株（24．2％）；混合感染183例（72．9％）。葡萄球菌对万古霉素和利奈唑胺的敏感率均为100％肺炎克雷伯菌和大肠埃希菌对碳青霉烯类耐药率低于5％铜绿假单胞菌对多粘菌素B耐药率（1．2％）最低，其次为阿米卡星（26．9％）、哌拉西林／他唑巴坦（33．2％），对碳青霉烯类耐药率超过60％；鲍曼氏不动杆菌对米诺环素、亚胺培南、氨苄西林／舒巴坦的耐药率不超过20％；白色念珠菌的耐药率低。结论VAP的主要病原菌为革兰阴性菌，混合感染率和细菌耐药率都很高。Objective To investigate the distribution and drug resistance of the pathogens responsible forventilator-associated pneumonia （ VAP ） in intensive care unit. Methods The etiological data on 251 patients who had been diagnosed as VAP from January 2008 to December 2010 in the ICU were analyzed retrospectively. Results A total of 737 pathogens were isolated, 346 （ 46.9% ） of which were gram-negative, mainly Pseudomonas aeruginosa （ 113 strains ）, Klehaeteria pneumoniae （ 58 strains ）, and Aeinetohaeter haumannii （ 57 strains ）; 213 （ 28.9% ） weregram-positive, mostly Staphylocoeeu.s aureus（ 91 strains, MRSA 63 strains ）, Staphylococcus epidermidis（ 45 strains ）, and Staphylococcus haemolytieus （ 42 strains ）; 178 （ 24.2% ） strains were fungi. Mixed infection developed in 183（ 72.9% ） patients. The sensitive rate of Staphyloeoeeusto vancomycin and linezolid was 100% ; the resistance rate of Klebsiellapneumoniae or Escheriehia colito carbapenem was less than 5% the resistance rate of Pseudomonas aeruginosa to polymyxin B was the lowest （ 1.2% ）, followed by amikacin （ 26.9% ）, piperacillin/tazobaetam （ 33.2% ）, and carbapenem （ more than 60% ] the resistance rate of Acinetobaeter baumanniito minocycline, imipenem, and ampicil-lin/sulbaetam were less than 20%. The resistance rates was lower in Candida albieans. Conclusions The main pathogen responsible for VAP is gram-negative bacteria. Rates of mixed infection and drug resistanee are very high.

关 键 词：呼吸机相关性肺炎 重症监护室 病原菌 抗药性 抗菌药物 

分 类 号：R446.5[医药卫生—诊断学]