摘要
目的探讨外科重症监护病房(SICU)黄杆菌科致呼吸机相关性肺炎(VAP)的临床特点、危险因素以及对抗菌药物的敏感性。方法分析SICU 29例黄杆菌科致呼吸机相关性肺炎的临床资料,29例患者痰液标本使用Microscan WalkAway-40微生物自动检测系统进行细菌学鉴定及药敏实验,并根据美国临床实验室标准化委员会(NCCLS)的标准判定结果。结果83.4%患者年龄>60岁,96.6%合并基础疾病,发生VAP前住SICU和机械通气平均天数分别为(23.1±9.2)d和(15.7±5.9)d,患者合并有≥1种侵入性操作;所有患者均有较长时间使用广谱抗菌药物史;细菌药敏报告提示,黄杆菌科耐药性较高,仅对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、复方新诺明较为敏感。结论高龄、合并基础疾病、长时间住SICU、广谱抗菌药物使用、侵入性操作、机械通气>2周是SICU患者发生黄杆菌科致呼吸机相关性肺炎的危险因素,哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、复方新诺明是抗感染治疗的首选。
OBJECTIVE To investigate the clinical characteristic and risk factors of ventilator-associated pneumonia （VAP） by Flavobacteriaceae in SICU and their antimicrobial susceptibility. METHODS The clinical data of 29 cases of VAP caused by Flavobacteriaceae in SICU and drug susceptibility were analyzed. Bacterial susceptibility testing was done by Microscan WalkAway40 and results were assessed according to NCCLS. RESULTS 83.4% Patients were older than 60 ; 96. 6% accompanied with underlying diseasesl the mean stay days in SICU and mechanical ventilation were 23. 1 ± 9.2 and 15.7 ± 5. 9 days before VAP; 83% patients required at least once invasive measurementsl all of the patients had been used with broad spectrum antibiotics for long time. Cefoperazone/sulbactam, piperacillin/tazobactam and trimethoprim-sulfamethoxazole were the most sensitive agents against Flavobacteriaceae. CONCLUSIONS The risk factors of VAP by Flavobacteriaceae in SICU are old age, with underlying diseases, stay in ICU for long time, required invasive treatment and more than two weeks of ventilation, Cefoperazone/sulbactam, plperacillin/tazobactam and trimethoprim-sulfamethoxazole may be the best choice for this infection.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2007年第4期391-393,共3页
Chinese Journal of Nosocomiology
