综合ICU呼吸机相关性肺炎病原菌分布及耐药性研究  

Study on pathogens and drug resistance of ventilator-associated pneumonia in comprehensive intensive care unit

作　　者：贾晓君[1] 易玲娴[1] 张长春[1] 张淑敏[1] 

机构地区：[1]解放军306医院重症监护室,北京100101

出　　处：《检验医学与临床》2014年第6期739-741,共3页Laboratory Medicine and Clinic

摘　　要：目的：分析综合重症监护病房（IC U ）呼吸机相关性肺炎病原菌的分布及耐药特性，为临床抗菌药物的合理应用提供依据。方法对解放军306医院综合IC U病房2012年1～12月进行机械通气大于48 h的122例患者进行回顾性分析，统计并分析呼吸机相关性肺炎病原菌分布特点及其耐药性。结果122例机械通气患者确诊为呼吸机相关性肺炎55例，发病率为45．08％。共检出病原菌122株，其中革兰阴性菌78株（63．93％），前3位依次为鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌，其中4株肺炎克雷伯菌为产超广谱β内酰胺酶（产ESBL ）。革兰阳性菌19株（15．57％），主要为金黄色葡萄球菌，检出1株耐万古霉素菌株；真菌25株（20．49％），主要为白色念珠菌。革兰阴性菌对氨苄西林、环丙沙星、亚胺培南、头孢曲松、优立新耐药明显。与不产ESBL菌株相比，产ESBL肺炎克雷伯菌对绝大多数常用抗菌药物耐药，而对亚胺培南和哌拉西林/他巴唑相对敏感。结论该院综合IC U呼吸机相关性肺炎的主要病原菌为革兰阴性菌，分析其耐药特性可为临床经验性治疗呼吸机相关性肺炎及合理使用抗菌药物提供依据。Objective To determine the distribution and drug resistance characteristic of pathogens in patients of comprehensive intensive care unit （ICU） with ventilator-associated pneumonia （VAP） ,and to provide evidence for rational suage of antibiotics .Methods A total of 122 patients receiving mechanical ventilation over 48 h were selected from January 2012 to December 2012 in this comprehensive ICU and the characteristic of pathogens and their drug resistance were retrospectively analyzed .Results Among 122 patients with mechanical ventilation ,55 cases were di-agnosed as VAP ,accounting for 45 .08% .Among 122 strains of pathogens collected ,78 strains were Gram-negative bacteria which accounted for 63 .93% .The most three pathogens were Acinetobacter baumanii ,Klebsiella pneumoniae and Pseudomonas aeruginosa ,with 4 strains of Klebsiella pneumoniae were found expressing extended spectrum beta-lactamases （ESBL） .19 strains of Gram-positive bacteria were isolated ,accounting for 15 .57% .The primary gram-positive bacteria was Staphylococcus aureus ,in which 1 strain was resistant to vancomycin .25 strains of fungi were i-solated ,accounting for 20 .49% ,mainly of which was Candida albicans .The Gram-negative bacteria were resistant to ampicillin ,ciprofloxacin ,imipenem ,ceftriaxone and unasyn obviously .Compared with ESBL negative Klebsiella pneu-moniae ,ESBL positive strains were resistance to the vast majority of antibiotics ,but were relatively sensitive to imi-penem and piperacillin/methimazole .Conclusion The primary pathogens of VAP could be Gram-negative bacteria in this comprehensive ICU .The analysis of pathogen and its drug resistance in VAP could provid evidence for the ra-tional usage of antibiotics for treating VAP .

关 键 词：呼吸机相关性肺炎 病原菌 耐药性 

分 类 号：R563.1[医药卫生—呼吸系统]