重症监护病房早发与晚发呼吸机相关性肺炎病原体耐药性差异  

Difference in drug resistance of pathogens causing early-and late-onset ventilator-associated pneumonia in an intensive care unit

作　　者：蒋述科[1] 罗彪峰[1] 李荣明[1] 陈晓燕[1] 李春凤[1] 徐镛男[1] 李林[1] 陶真开 

机构地区：[1]桂林医学院附属医院,广西桂林541001

出　　处：《中国感染控制杂志》2014年第4期208-211,共4页Chinese Journal of Infection Control

摘　　要：目的了解某院重症监护病房(ICU)呼吸机相关性肺炎(VAP)发生及病原菌耐药情况。方法对该院ICU2011年1月—2012年12月间使用机械通气时间>48 h的住院患者VAP发生情况进行调查,比较早发VAP(E-VAP,机械通气时间≤4 d)和晚发VAP(L-VAP,机械通气时间>4 d)病原菌及其耐药情况。结果共调查患者176例,VAP发生率为44.32%(78例);随着呼吸机使用时间的延长,VAP的发生率逐渐增高(χ2=52.561,P<0.001)。L-VAP发生率为58.33%(70/120),显著高于E-VAP的14.29%(8/56),差异有统计学意义(χ2=30.02,P<0.001)。分离病原体178株,其中革兰阴性(G-)菌104株(58.43%),革兰阳性(G+)菌46株(25.84%)、真菌28株(15.73%);分离多重耐药菌/泛耐药菌97株(54.49%)。L-VAP患者多重耐药菌/泛耐药菌分离率(58.86%,93株)显著高于E-VAP患者(20.00%,4株),L-VAP患者分离的主要病原菌耐药率显著高于EVAP患者(均P<0.05))。真菌感染仅发生在L-VAP患者,其总体耐药率为12.14%。结论呼吸机使用时间的延长,可增加VAP的发生率;L-VAP患者感染的病原体耐药率高。Objective To study the incidence of ventilator-associated pneumonia（VAP）and antimicrobial resistance of pathogens in an intensive care unit（ICU）.Methods The occurrence of VAP in hospitalized patients with mechan-ical ventilation〉48 hours between January 2011 and December 2012 were investigated,species and antimicrobial re-sistance of pathogens causing early onset-VAP （E-VAP,mechanical ventilation≤4 d）and late-onset VAP（L-VAP, mechanical ventilation〉4 d）were compared.Results A total of 1 76 patients were investigated,incidence of VAP was 44.32% （78 cases）;With the prolongation of mechical ventilation,incidence of VAP increased gradually （χ2=52.561,P〈0.001）.The incidence of L-VAP was significantly higher than E-VAP （58.33% [70/120]vs 14.29%[8/56]）（χ2= 30.02,P〈0.001）.A total of 178 pathogens were isolated,gram-negative bacteria,gram-positive bac-teria and fungi were 104（58.43% ）,46（25.84% ）,and 28（15.73% ）isolates respectively;97（54.49% ）multidrug-resistance/pandrug resistance organisms （MDRO）were isolated. MDRO isolation rate in L-VAP patients was high-er than E-VAP patients（[58.86% ,n= 93]vs [20.00% ,n= 4]）,resistance rate of major pathogens causing L-VAP was significantly higher than E-VAP patients（all P〈0.05）.Fungi infection only occurred in L-VAP patients,the total antimicrobial resistance rate was 12.14% .Conclusion The prolongation of mechanical ventilation can increase the incidence of VAP,and resistance rate of pathogen in L-VAP is high.

关 键 词：呼吸机相关性肺炎 病原体 耐药性 抗药性 微生物 重症监护病房 医院感染 感染控制 

分 类 号：R181.32[医药卫生—流行病学]