ICU呼吸机相关性肺炎病原菌的耐药性研究  

Antimicrobial resistance of pathogenic bacteria causing ventilator-associated pneumonia in ICU

作　　者：周铭[1] 刘学政[1] 董虹[1] 

机构地区：[1]长江大学附属第一医院检验科,湖北荆州434000

出　　处：《中华医院感染学杂志》2013年第10期2475-2477,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨医院ICU呼吸机相关性肺炎(VAP)病原菌耐药性,为临床医护人员防治VAP提供实验室参考依据。方法对医院ICU 2010年1月-2011年12月发生VAP的299例患者的病案进行回顾性调查,使用密闭式痰液收集器采集患者下呼吸道痰液标本,按照《全国临床检验操作规程》进行细菌培养,采用法国生物梅里埃公司VITEK-32微生物仪进行菌种鉴定,遵照CLSI推荐的K-B法进行药敏试验,依据CLSI 2010-2011年折点判读敏感、中介、耐药结果。结果 313例VAP患者下呼吸道痰液分离出342株病原菌,其中革兰阴性杆菌分离率最高,占75.1%,其次为革兰阳性球菌占17.3%,真菌占7.6%;前3位病原菌依次为鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌,分占17.0%、14.9%、14.3%;铜绿假单胞菌和鲍氏不动杆菌泛耐药菌株的检出率分别为21.6%、27.6%,产ESBLs细菌检出率为54.8%,革兰阳性球菌中,耐甲氧西林金黄色葡萄球菌检出率为53.7%;ICU VAP检出的病原菌均出现了严重的耐药性。结论医院应逐条落实卫生部颁发的《抗菌药物临床应用管理办法》,实行抗菌药物临床应用的分级管理和医院内耐药细菌流行的预警机制,制定有效的VAP防治措施,降低VAP发病率,提高ICU患者抢救成功率和临床治愈率。OBJECTIVE To explore the antimicrobial resistance of pathogenic bacteria causing ventilator-associated pneumonia （VAP） in ICU so as to provide the reference for clinical prevention and treatment of VAP. METHODS The medical records of 299 VAP patients who enrolled the hospital from Jan 2010 to Dec 2012 were retrospectively reviewed. The closed sputum collector was used to collect sputum samples from lower respiratory tract. By referring to National Guide to Clinical Laboratory Procedures, the bacterial cultivation was carried out. VITEK-32 system （BioMerieux, France） was applied to identify the strains. By complying with the KB method recommended by CLSI, the susceptibility testing was performed. The results of the drug susceptibility testing were assessed according to CLSI2010-2011 breakpoints. RESULTS Totally 342 strains of pathogens were isolated from the respiratory tract sputum specimens obtained from 313 VAP patients,among which the isolation rate of the gram- negative bacilli was the highest （75.1%）, followed by the gram-positive coccci （17.3%） and the fungi （7.6%）. The Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae were the top three species of pathogens, accounting for 17.0%, 14.9%, and 14.3%, respectively. The isolation rate of the pandrug-resistant P. aeruginosa was 21.6%, the pandrug-resistant A. baumannii 27.6% % the isolation rate of the ESBLs-producing strains was 54. 8Y00% among the gram-positive cocci, the detection rate of methicillin-resistant Staphylococcus aureus （MRSA） was 53.7%. The pathogens causing VAP in the ICU were highly drug-resistant. CONCLUSION The hospital should implement the Clinical Management Approach of Antibiotics Use issued by the Ministry of Health, the hierarchical management of the clinical use of antibiotics and the warning mechanism of spread of drug-resistant bacteria are implemented, the effective prevention measures of VAP have been developed, the incidence of VAP has been reduced, and both the rate of successful re

关 键 词：重症监护病房 呼吸机相关性肺炎 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]