迟发型呼吸机相关性肺炎易感因素及其常见病原谱特征  

Predisposing factors and pathogenic spectrum of patients with late-onset ventilator-associated pneumonia

作　　者：周仲伟[1] 邹俊[1] 

机构地区：[1]四川省医学科学院.四川省人民医院呼吸内科,成都市610072

出　　处：《中华实验和临床感染病杂志（电子版）》2013年第1期80-83,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的探讨呼吸科重症监护病房(RICU)迟发型呼吸机相关性肺炎(VAP)患者的易感因素及其主要致病菌的分布和耐药性。方法收集2005年1月～2011年12月,本院呼吸科RICU收治的92例接受机械通气后发生迟发型呼吸机相关性肺炎(VAP)的患者临床资料,对可能影响VAP发生的危险因素、主要病原菌分布及其耐药性情况进行回顾性分析。结果本研究中,影响迟发型VAP发生的危险因素包括年龄、血清白蛋白水平、合并支气管肺疾病、机械通气时间、糖皮质激素及抗菌药物的使用等。本组92例VAP患者病原菌以革兰阴性杆菌为主(63/92,68.5%),其中,铜绿假单胞菌(16/63,25.4%)、鲍曼不动杆菌(13/63,20.6%)和肠杆菌科细菌(12/63,19.0%)分别位居前3位。其中铜绿假单胞菌多耐药株(PDR-PA)和鲍曼不动杆菌多耐药株(PDR-Ab)分别占铜绿假单胞菌和鲍曼不动杆菌的12.3%(2/16)和23.1%(3/13);产ESBLs的菌株则占肠杆菌科的58.3%(7/12)。结论 RICU内迟发型VAP的发生受多种易感因素影响,其主要病原菌是革兰阴性杆菌;对行有创机械通气的患者应加强下呼吸道分泌物的病原学和抗菌药物耐药性监测。Objective To study the predisposing factors, distribution and drug resistance of major pathogens in Respiratory Intensive Care Unit （RICU） of patients with late-onset ventilator-associated pneumonia （VAP）. Methods The clinical data of 92 patients in RICU from January 2005 to December 2011 undergoing mechanical ventilation （MV）were collected and the predisposing factors, distribution and drug resistance of major pathogens for late-onset VAP were analyzed, retrospectively. Results The age, nutritional state, serum albumin levels, bronchopulmonary disease, MV duration, the application of glucocorticoids and antibiotics before MV were the predisposing factors for late-onset VAP. The main pathogen among those 92 patients was gram negative bacillus （63/92, 68.5% ）, which included 25.4% （ 16/63 ） of Pseudomonas aeruginosa （PA） , 20.6% （ 13/63 ） of Acinetobacter baumanii （AB） and 19.0% （12/63） of Enterobacteria. The pan-drug-resistant rate was about 12. 3% （2/16） in PA and 23. 1% （3/13） in AB. ESBLs （ ＋ ） strain accouted about 58.3% （7/12） in Enterobacteria. Conclusions The occurrence of late-onset VAP in RICU is affected by many predisposing factors, with gram-negative bacillus as main pathogen. It is necessary to strengthen the monitoring of pathogens and antibiotic resistance in lower respiratory tract secretions of patients with MV.

关 键 词：呼吸机相关性肺炎 迟发型 易感因素 病原谱 耐药性 

分 类 号：R446.5[医药卫生—诊断学]