呼吸机相关性肺炎病原菌分布与耐药性研究  

Distribution and drug resistance of pathogens causing ventilator-associated pneumonia

作　　者：谢多双[1] 明星[1] 胡荍[1] 罗清钦[1] 符湘云[1] 王惠芳[1] 熊薇[2] 

机构地区：[1]湖北医药学院附属太和医院防保感控处,湖北十堰442000 [2]华中科技大学同济医学院附属同济医院感染管理科,湖北武汉430030

出　　处：《中华医院感染学杂志》2014年第21期5245-5246,5257,共3页Chinese Journal of Nosocomiology

基　　金：湖北省教育厅科研基金资助项目(B20112119);十堰市科学技术研究基金资助项目(2010st16);湖北医药学院附属太和医院博士科研基金项目(2011QD06)

摘　　要：目的探讨和验证早发型与迟发型呼吸机相关性肺炎(VAP)病原菌构成及耐药性差异,为防治VAP提供依据。方法资料来自于湖北省医院感染监控网2007-2010年监测资料,分析湖北省13所三级甲等医院入住ICU使用呼吸机4 155例患者进行队列随访,统计比较早发型和迟发型VAP病原菌和耐药率。结果共868例患者诊断为VAP,其中早发型VAP352例、迟发型VAP516例;VAP发病率为20.89%,发病密度为28.90/1000机械通气日;早发型VAP患者前3位病原菌依次为铜绿假单胞菌、金黄色葡萄球菌、嗜麦芽寡养单胞菌,分别占14.71%、13.21%、12.31%,迟发型依次为铜绿假单胞菌、鲍氏不动杆菌、嗜麦芽寡养单胞菌,分别占23.58%、19.65%、9.82%;两型VAP病原菌构成比较,差异有统计学意义;迟发型VAP病原菌耐药率普遍高于早发型VAP,耐药率两组之间比较差异有统计学意义。结论早发型与迟发型VAP病原菌构成和耐药率之间有显著差异,诊疗VAP患者时应注意区别。OBJECTIVE To explore the distribution and drug resistance of pathogens causing early onset and late onset ventilator-associated pneumonia （ VAP） so as to provide guidance for prevention and treatment of VAP . METHODS The monitoring data were collected from the monitoring net of nosocomial infections of Hubei province from 2007 to 2010 ,then the cohort follow-up was conducted for 4 155 patients who used ventilators in the ICUs of 13 three-A hospitals in Hubei province ,and the distribution and the drug resistance of the pathogens causing the early onset and late onset VAP were statistically analyzed and compared .RESULTS Totally 868 patients were diag-nosed as the VAP ,including 352 cases of early onset VAP and 516 cases of late onset VAP .The incidence of VAP was 20 .89% ,and the incidence intensity was 28 .90 per 1000 mechanical ventilation day .The Pseudomonas aeruginosa ,Staphylococcus aureus ,and Stenotrophomonas maltophilia ranked the top three species of pathogens causing the early onset VAP ,accounting for 14 .71% ,13 .21% ,and 12 .31% ,respectively ;while the P .aerugi-nosa ,Acinetobacter baumannii ,and S .maltophilia were the predominant pathogens causing the late onset VAP , accounting for 23 .58% ,19 .65% ,and 9 .82% ,respectively .As compared with the constituent ratios of the pathogens causing the two types of VAP ,the difference was statistically significant .The drug resistance rate of the pathogens causing the late onset VAP was generally higher than that of the pathogens causing the early onset VAP , there was statistically significant difference in the drug resistance rate between the two groups . CONCLUSION There is significant difference in the distribution or the drug resistance rate between the pathogens causing the early onset VAP and those causing the late onset VAP .

关 键 词：呼吸机相关肺炎 病原菌 耐药率 重症监护病房 

分 类 号：R378[医药卫生—病原生物学]