呼吸重症监护病房中不同类型医院获得性肺炎的病原菌构成及耐药性差异  

Pathogens and their resistant patterns in different types of hospital-acquired pneumonia in respiratory intensive care unit

作　　者：于洪涛[1] 贾金广 康运凯[1] 王敏[1] 李飞[1] 王红军[1] 郭彩霞[1] 吴红科[1] 杜娟[1] 

机构地区：[1]郑州人民医院呼吸科,郑州450003

出　　处：《中国感染与化疗杂志》2013年第5期384-387,共4页Chinese Journal of Infection and Chemotherapy

基　　金：河南省卫生厅项目(豫卫科【2011】16号)

摘　　要：目的了解呼吸重症监护病房(RICU)医院获得性肺炎(HAP,指住院48 h后获得的肺炎而与呼吸机使用无关)和呼吸机相关性肺炎(VAP)的病原菌构成及耐药性差异。方法对2011年4月—2012年4月郑州人民医院RICU收治的56例HAP和19例VAP患者下呼吸道分泌物进行细菌学鉴定和耐药性分析。结果 VAP和HAP中病原菌以革兰阴性菌为主。鲍曼不动杆菌是VAP(46.7%)和HAP(21.7%)的主要病原菌;与HAP比较,VAP中鲍曼不动杆菌所占比率更高(P<0.05)。铜绿假单胞菌在VAP(30.0%)和HAP(32.5%)中也占较高的比率。在VAP和HAP中,鲍曼不动杆菌对头孢哌酮-舒巴坦的敏感率高于60.0%,在VAP患者中,鲍曼不动杆菌对米诺环素的敏感率高于70.0%,铜绿假单胞菌对抗菌药物耐药率较低的有哌拉西林-他唑巴坦(11.1%)、头孢哌酮-舒巴坦(22.2%)和多黏菌素B(11.1%)。在HAP中,铜绿假单胞菌对抗菌药物耐药率较低的有阿米卡星(7.4%)、头孢哌酮-舒巴坦(11.1%)、头孢他啶(18.5%)和头孢吡肟(22.2%)。结论在VAP和HAP中,主要的病原菌是革兰阴性菌。米诺环素和头孢哌酮-舒巴坦治疗鲍曼不动杆菌感染的VAP和HAP仍有价值。哌拉西林-他唑巴坦和阿米卡星仍然可以作为铜绿假单胞菌感染的VAP和HAP经验治疗药物。Objective To explore the pathogenic bacteria and drug resistant patterns in different types of hospital acquired pneu monia （HAP, defined as the pneumonia acquired 48 h after admission and not associated with respirator） in respiratory inten- sive care unit （RICU）. Methods Retrospective cohort study was used to analyze the bacteriological data and susceptibility tes- ting data of the bacterial pathogens isolated from lower respiratory tract secretions of 56 HAP patients and 19 VAP patients in RICU from April 2011 to April 2012. Results gram-negative bacteria were the major pathogens in both VAP and HAP. Acine- tobacterbaurnannii was a major pathogenic bacteria of VAP （46.7%） and HAP （21.7%）. A. baumannii was more prevalent in VAP than in HAP （P〈0.05）. Pseudornonas aeruginosa was also prevalent in VAP （30.0%） and HAP （32.5%）. More than 60.0% of the A. baumannii strains from VAP and HAP patients were susceptible to cefoperazone sulbactam. More than 70.0% of the A. baunlannii strains from VAP patients were susceptible to minocycline. Relatively fewer strains of P. aerugi- nosa from VAP patients were resistant to piperaeillin-tazobactam （11.1% ）, cefoperazone-sulbactam （22.2 % ）, or polymyxin B （11. l%）. As for the P. aeruginosa strains from HAP patients, relatively fewer strains were resistant to amikacin （7.4%）, cefoperazone-sulbactam （11.1 %）, eeftazidime （18.5 %） and cefepime （22.2 % ）. Conclusions The main pathogens in both VAP and HAP patients are gram negative bacteria. Minocycline and cefoperazone-sulbactam are still valuable in the treatment of VAP and HAP caused by A. baumannii. Piperacillin- tazobactam and amikacin are still useful for empirical treat- ment of the VAP and HAP caused by P. aeruginosa.

关 键 词：医院获得性肺炎 呼吸机相关性肺炎 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]