ICU革兰阴性菌呼吸机相关肺炎患者下呼吸道分泌物培养及耐药性分析  

Analysis of culture and drug resistance of lower respiratory tract secretion from 63 patients with gram-negative ventilator-associated pneumonia in ICU of our hospital

作　　者：楚巧红[1] 乔霞 王丽萍[1] Chu Qiaohong;Qiao Xia;Wang Liping(Second Hospital,Luohe Medical College,Luohe 462300,China)

机构地区：[1]漯河医学高等专科学校第二附属医院感染管理科,462300

出　　处：《国际医药卫生导报》2020年第8期1083-1085,共3页International Medicine and Health Guidance News

摘　　要：目的探究重症监护病房(ICU)呼吸机相关肺炎(VAP)患者下呼吸道分泌物革兰阴性菌分布及耐药性。方法选取本院2017年10月至2019年4月ICU革兰阴性菌VAP患者63例,采集下呼吸道分泌物,行细菌培养及药敏试验。结果63例患者共培养革兰阴性菌137株,其中铜绿假单胞菌49株(35.77%),鲍曼不动杆菌36株(26.28%),肺炎克雷伯菌27株(19.71%),阴沟肠杆菌10株(7.30%),嗜麦芽窄食单胞菌9株(6.57%),其他革兰阴性菌6株(4.38%);铜绿假单胞菌对亚胺培南、阿米卡星、头孢吡肟耐药率较低,分别为18.37%、22.45%、24.29%;鲍曼不动杆菌对亚胺培南、氧氟沙星耐药率较低,分别为11.11%、22.22%;肺炎克雷伯菌对亚胺培南、美罗培南耐药率较低,均为3.70%。结论ICU革兰阴性菌VAP主要致病菌以铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌为主,临床治疗可以亚胺培南作为经验用药;细菌培养及药敏试验可明确病原菌构成,对临床合理使用抗生素有积极作用。Objective To investigate the distribution and drug resistance of Gram-negative bacteria in lower respiratory tract secretion from patients with ventilator-associated pneumonia(VAP)in intensive care unit(ICU).Methods A total of 63 patients with Gram-negative bacterial VAP from ICU in our hospital between October,2017 and April,2019 were enrolled.The lower respiratory tract secretion was collected and tested for bacterial culture and drug susceptibility.Results A total of 137 Gram-negative bacteria from the 63 patients were cultured,including 49 strains of Pseudomonas aeruginosa(35.77%),36 strains of Acinetobacter baumannii(26.28%),27 strain Klebsiella pneumoniae(19.71%),10 strains of Enterobacter cloacae(7.30%),9 strains of Stenotrophomonas maltophilia(6.57%),and 6 strains of other Gram-negative bacteria(4.38%).The resistance rates of Pseudomonas aeruginosa to imipenem,amikacin,and cefepime were 18.37%,22.45%,and 24.29%,respectively.The resistance rates of Acinetobacter baumannii to imipenem and ofloxacin were 11.11%and 22.22%,respectively.The resistance rates of Klebsiella pneumoniae to imipenem and meropenem both were 3.70%.Conclusion The main pathogens of Gram-negative bacteria VAP in ICU are Pseudomonas aeruginosa,Acinetobacter baumannii,and Klebsiella pneumoniae.Clinical treatment can use imipenem as an empirical drug.Bacterial culture and drug susceptibility test can be used.Defining the composition of pathogens has a positive effect on the rational use of antibiotics.

关 键 词：呼吸机相关肺炎 重症监护病房 下呼吸道 药敏试验 

分 类 号：R4[医药卫生—临床医学] R563