胸心外科ICU呼吸机相关性肺炎的病原菌分布与耐药性分析  

Distribution and drug resistance of pathogens isolated from patients with ventilator-associated pneumonia in ICU of cardiothoracic surgery department

作　　者：朱希燕[1] 李晓峰[1] 张荣泽[1] 张海燕[1] 袁彩欣[1] 

机构地区：[1]河北医科大学第四医院胸五科,河北石家庄050011

出　　处：《中华医院感染学杂志》2016年第17期4035-4037,共3页Chinese Journal of Nosocomiology

基　　金：河北省医学科学研究重点基金资助项目(20150768)

摘　　要：目的分析胸心外科重症监护病房(ICU)呼吸机相关性肺炎(VAP)的病原菌分布和耐药性,为制定临床抗感染治疗方案提供客观依据。方法选取2010年1月-2014年12月在胸心外科ICU治疗的200例VAP患者作为研究对象,对其痰液标本的病原菌分布及其耐药性进行检测和分析;采用SPSS17.0软件进行统计分析。结果 200例VAP患者痰标本中共分离出病原菌133株,检出率为66.5%,其中,革兰阴性菌126株占94.7%,革兰阳性菌4株占3.0%,真菌3株占2.3%;鲍氏不动杆菌对大多数抗菌药物耐药率均较高,对米诺环素的耐药率较低,检出15株多药耐药菌株,检出率为26.8%;铜绿假单胞菌对头孢菌素类抗菌药物的耐药率较高,对米诺环素、磺胺甲噁唑/甲氧苄啶、阿米卡星的耐药率较低,检出7株多药耐药菌株,检出率为25.9%;金黄色葡萄球菌对大多数抗菌药物的耐药率较高,但未发现对万古霉素、替考拉宁、利奈唑胺耐药的菌株,检出耐甲氧西林金黄色葡萄球菌3株,检出率为75.0%。结论胸心外科ICU VAP患者的病原菌分布及其耐药性具有一定的特征性,临床医师应对其进行严密的监测和准确的辨别,选用敏感的抗菌药物进行抗感染治疗,以提高治疗效果并减少耐药菌株的产生。OBJECTIVE To explore the distribution and drug resistance of pathogens isolated from patients with ventilator-associated pneumonia（VAP）of ICU of cardiothoracic surgery department so as to formulate plans for clinical treatment of infections.METHODS A total of 200 patients with VAP who were treated in the ICU of cardiothoracic surgery department from Jan 2010 to Dec 2014 were recruited as the study objects,then the distribution and drug resistance of pathogens isolated from sputum specimens were detected and analyzed,and the statistical analysis was performed with the use of SPSS17.0software.RESULTS Totally 133 strains of pathogens were isolated from the sputum specimens of the 200 VAP patients,with the isolation rate 66.5%;there were 126（94.7%）strains of gram-negative bacteria,4（3.0%）strains of gram-positive bacteria,and 3（2.3%）strains of fungi.The Acinetobacter baumannii strains were highly resistant to most of the antibiotics,and the drug resistance rate to minocycline was relatively low.Totally 15 strains of multidrug-resistant A.baumannii were isolated,with the isolation rate 26.8%.The Pseudomonas aeruginosa strains were highly resistant to cephalosporins,while the drug resistance rates to minocycline,sulfamethoxazole-trimethoprim,and amikacin were relatively low;totally 7strains of multidrug-resistant P.aeruginosa were isolated,with the isolation rate 25.9%.The Staphylococcus aureus strains were highly resistant to most of the antibiotics,the strains that were resistant to vancomycin,teicoplanin,or linezolid were not found,and 3strains of methicillin-resistant S.aureus were isolated,with the isolation rate 75.0%.CONCLUSIONThe distribution and drug resistance of the pathogens isolated from the VAP patients of ICU of cardiothoracic surgery department show certain characteristics.It is necessary for the clinician to closely monitor and identify accurately and choose sensitive antibiotics for treatment of infections so as to improve the therapeutic effect and reduce the drug-resistant strains.

关 键 词：胸心外科 重症监护病房 呼吸机相关性肺炎 病原菌分布 耐药性分析 

分 类 号：R378[医药卫生—病原生物学]