236例ICU呼吸机相关性肺炎患者病原菌分布及耐药性分析  

Investigation and analysis of distribution and drug resistance of pathogen in 236 ICU patients with ventilator-associated pneumonia

作　　者：钟晓莉[1] 余林[2] 邓海波[3] 张帆 罗洲 ZHONG Xiaoli;YU Lin;DENG Haibo;ZHANG Fan;LUO Zhou(General Medicine Department,Jianyang People's Hospital,Jianyang,Sichuan 641400,China;Department of Respiratory and Critical Care Medicine,First Affiliated Hospital of Chengdu Medical College;Respiratory Department,Jianyang People's Hospital;Intensive Care Unit,Jianyang People's Hospital;Hospital Infection Department,Jianyang People's Hospital)

机构地区：[1]简阳市人民医院全科医学科,四川简阳641400 [2]成都医学院第一附属医院呼吸与危重医学科 [3]简阳市人民医院呼吸内科 [4]简阳市人民医院重症监护室 [5]简阳市人民医院院感科

出　　处：《中国病原生物学杂志》2024年第7期838-841,共4页Journal of Pathogen Biology

基　　金：四川省教育厅自然科学基金项目(No.17ZB0134)。

摘　　要：目的 了解236例重症监护病房(ICU)呼吸机相关性肺炎(VAP)患者的病原菌分布及耐药情况。方法 收集2020年1月至2022年12月236例ICU且诊断为VAP的患者的痰液样本,进行病原菌培养、鉴定以及药敏试验,采用描述性分析方法分析结果。结果 236例VAP患者的痰液样本共分离到病原菌307株,包括革兰阴性菌264株(占85.99%)、革兰阳性菌34株(占11.07%)、真菌9株(占2.93%)。不同年份的病原菌分布比较差异无统计学意义(χ^(2)=1.034,P=0.905)。鲍曼不动杆菌仅对替加环素的耐药率较低(<30%),对其他抗菌药物耐药率均>30%。铜绿假单胞菌对环丙沙星、左氧氟沙星、阿米卡星的耐药率较低(<15%),对其他抗菌药物耐药率均>15%。肺炎克雷伯杆菌对氨苄西林的耐药率最高(100%),对哌拉西林/他唑巴坦、亚胺培南、替加环素的耐药率较低(<10%),对其他抗菌药物耐药率均>20%。金黄色葡萄球菌仅对青霉素、红霉素、克林霉素、头孢唑林、四环素的耐药率高(>80%),对妥布霉素、环丙沙星的耐药率尚可(≥20%但<40%),对替考拉宁、利奈唑胺、万古霉素、复方新诺明敏感(耐药率均为0%)。结论 236例ICU VAP患者的病原菌以革兰阴性菌为主,不同病原菌的耐药性存在差异,临床当依据病原菌培养及药敏试验科学选用抗菌药物。Objective To investigate and analyze the distribution and drug resistance of pathogens in 236 patients with ventilator associated pneumonia(VAP)in an intensive care unit(ICU)of hospital.Methods Sputum samples were collected from 236 VAP patients in ICU from January 2020 to December 2022,the pathogen cultivation,identification,and drug sensitivity tests were conducted,and descriptive analysis methods were used to analyze the results.Results A total of 307 strains of pathogenic bacteria were isolated from sputum samples of 236 VAP patients,including 264 strains of Gram negative bacteria(85.99%),34 strains of Gram positive bacteria(11.07%),and 9 strains of fungi(2.93%).There was no statistically significant difference in the distribution of pathogenic bacteria among different years(χ^(2)=1.034,P=0.905).The resistance rate of Acinetobacter baumannii to tigecycline was relatively low(<30%),while its resistance rate to other antibiotics was>30%.The resistance rate of Pseudomonas aeruginosa to ciprofloxacin,levofloxacin,and amikacin was relatively low(<15%),while its resistance rate to other antibiotics was>15%.Klebsiella pneumoniae had the highest resistance rate to ampicillin(100%),while its resistance rate to piperacillin/tazobactam,imipenem,and tigecycline was relatively low(<10%),and its resistance rate to other antibiotics was>20%.Staphylococcus aureus had a high resistance rate to penicillin,erythromycin,clindamycin,cefazolin,and tetracycline(>80%),while its resistance rate to tobramycin and ciprofloxacin was still acceptable(≥20%but<40%),and it was sensitive to teicoplanin,linezolid,vancomycin,and compound sulfamethoxazole(all with a resistance rate of 0%).Conclusion Gram negative bacteria are the main pathogens in 236 ICU VAP patients,and there are differences in drug resistance among different pathogens.In clinical practice,antibiotics should be scientifically selected based on pathogen culture and drug sensitivity testing.

关 键 词：重症监护病房 呼吸机相关性肺炎 病原菌分布 耐药性 

分 类 号：R446.5[医药卫生—诊断学]