综合重症监护病房患者呼吸机相关性肺炎的病原学和耐药性分析

目的探讨病原菌在综合重症监护病房(ICU)患者呼吸机相关性肺炎(VAP)中的分布及对常用抗生素的耐药情况。方法对我院2004-2006年综合ICU患者VAP病原菌的分布及耐药性进行回顾性统计分析。结果从302例综合ICU VAP患者下呼吸道深部分泌物标本中分离出347株病原菌,主要病原菌是铜绿假单胞菌(32.3%)、鲍曼不动杆菌(31.1%)、金黄色葡萄球菌(16.7%)、克雷伯菌(7.5%)与凝固酶阴性葡萄球菌(6.1%)。革兰阴性杆菌(G-杆菌)对哌拉西林、头孢噻肟耐药率最高,对碳青霉烯类及加酶抑制剂抗生素耐药率最低;革兰阳性球菌(G 球菌)对青霉素类、克林霉素及红霉素耐药率高,对万古霉素、喹诺酮类抗生素耐药率低。结论G-杆菌是综合ICU患者VAP最主要的病原菌,多重耐药性高;耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MR-SCNS)的分离率高且耐药严重。临床医师应根据病原菌学及抗菌药物敏感性资料,及时选择合理的抗生素控制感染,延缓耐药菌株的产生。

Distribution and antibacterial resistance of pathogens of ventilator-associated pneumonia in general intensive care unit

Objective To investigate the distribution and drug resistance of pathogens of ventilator-associated pneumonia(VAP) in general intensive care unit(ICU).Methods Statistical methods were used to analyze retrospectively the data of pathogens and drug resistance of VAP in general ICU from 2004 to 2006.Results Totally 347 pathogens were isolated from deep-part secretion of lower respiratory tracts of 302 VAP in general ICU.The main pathogens included Pseudomonas aeruginosa(32.3%),Acinetobacter baumanii(31.1%),Staphylococcus aurous(16.7%),Klebsiella(7.5%) and Coagulase-negative Staphylococci(6.1%).Gram-negative bacillus showed a high resistance to piperacillin and Cefotaxime but high susceptibility to carbapenems and the enzyme inhibitor antibiotics.Gram-positive coccobacteria showed a high resistance to Penicillin,Clindamycin and Erythromycin but high susceptibility to Vancomycin and Quinolone.Conclusion Gram-negative bacillus was the main pathogen of VAP in general ICU,multidrug resistance was serious.The rate of methicillin-resistant staphylococcus aurous(MRSA) and methicillin-resistant coagulase-negative staphylococci(MRCNS) was high,with serious drug resistance.According to the data of the bacteria pathogen and antibiotics susceptibity,we can select antibiotics reasonably to control the infection and delay the emergency of new drug-resistant bacteria.