颅脑损伤合并呼吸机相关性肺炎患者机械通气时间与病原菌分布及耐药性的关系  

Relationship between mechanical ventilation time and pathogen distribution and drug resistance in patients with craniocerebral Injury complicated with ventilator-associated pneumonia in ICU

作　　者：徐巧莲[1] 陈永铭[1] 施乾坤[1] 颞帅 付润 谢蓉蓉 XU Qiao-lian;CHEN Yong-ming;SHI Qian-kun;NIE Shu-ai;FU Run;XIE Rong-rong(Department of Critical Care Medicine,Nanjing First Hospital,Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]南京医科大学附属南京医院南京市第一医院重症医学科,江苏南京210009

出　　处：《中国病原生物学杂志》2022年第3期325-328,共4页Journal of Pathogen Biology

摘　　要：目的探讨机械通气时间与ICU颅脑损伤合并呼吸机相关性肺炎患者病原菌分布及其耐药性的关系。方法选取142例ICU颅脑损伤合并呼吸机相关性肺炎患者为研究对象,其中机械通气时间>1周的65例为A组,机械通气时间≤1周的77例为B组。分析两组患者的痰培养检查结果;对比两组患者不同类型病原菌及特殊类型病原菌的检出率;对比两组患者主要病原菌的耐药率。结果两组患者共检出病原菌166株(A组78株,B组88株),均以革兰阴性菌为主要致病菌(69.23%、62.50%)。两组患者均以金黄色葡萄球菌为主要革兰阳性致病菌,而肺炎克雷伯菌、铜绿假单胞菌为主要革兰阴性致病菌。A组革兰阳性菌的检出率显著低于B组,而鲍曼不动杆菌及真菌的检出率则显著高于B组(P<0.05)。A组多重耐药鲍曼不动杆菌(MDRAB)的检出率显著高于B组(P<0.05)。两组患者均未发现对万古霉素、替考拉宁、利奈唑胺耐药的金黄色葡萄球菌、肺炎链球菌菌株。A组检出的金黄色葡萄球菌对阿莫西林克拉维酸、头孢唑林以及左氧氟沙星的耐药率显著高于B组(均P<0.05)。A组检出的肺炎克雷伯菌对亚胺培南、左氧氟沙星的耐药率显著高于B组(P<0.05),A组检出的铜绿假单胞菌对左氧氟沙星的耐药率显著高于B组(P<0.05)。结论革兰阴性菌是ICU颅脑损伤合并呼吸机相关性肺炎患者的主要致病菌,且随着机械通气时间的增加,患者更容易发生多重耐药菌感染。临床应尽量缩短患者机械通气时间,加强呼吸机相关性肺炎防治,减少多重耐药菌感染发生。Objective To investigate the relationship between mechanical ventilation time and pathogen distribution and drug resistance in patients with craniocerebral injury complicated with ventilator-associated pneumonia in ICU.Methods 142 patients with craniocerebral injury complicated with ventilator-associated pneumonia in ICU were selected.65 patients with mechanical ventilation time>1 week were divided into group A and 77 patients with mechanical ventilation time≤1 week were divided into group B.The sputum culture results of the two groups were analyzed.The detection rates of different types of pathogens and special types of pathogens were compared between the two groups.The drug resistance rates of the main pathogens in the two groups were compared.Results 166 strains of pathogenic bacteria were detected in the two groups(78 strains in group A and 88 strains in group B).Gram negative bacteria were the main pathogenic bacteria in both groups(69.23%and 62.50%).Staphylococcus aureus was the main Gram-positive pathogen(11.54%and 17.05%),while Klebsiella pneumoniae and Pseudomonas aeruginosa were the main Gram-negative pathogens in both groups(20.51%and 27.27%),(20.51%and 15.91%).The detection rate of Gram-positive bacteria in group A was 21.79%,which was significantly lower than that in group B,while the detection rates of Acinetobacter baumannii and fungi were 12.82%and 8.97%,which were significantly higher than those in group B(P<0.05).The detection rates of multidrug resistant A.baumannii(MDRAB)in group A was 8.97%,which was significantly higher than that in group B(P<0.05).No strains of S.aureus and S.pneumoniae resistant to vancomycin,teicoplanin and linezolid were found in both groups.The resistance rates of S.aureus detected in group A to amoxicillin,clavulanic acid,cefazolin and levofloxacin were significantly higher than those in group B(P<0.05).The resistance rates of K.pneumoniae detected in group A to sulbactam,imipenem and levofloxacin were significantly higher than those in group B(P<0.05),and the resist

关 键 词：机械通气 颅脑损伤 呼吸机相关性肺炎 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]