摘要
目的探讨重症监护病房(ICU)呼吸机相关性肺炎(VAP)病原菌分布特点及对抗菌药物的耐药性,为合理应用抗菌药物、预防和减少VAP的发生提供指导依据。方法对2006年1月-2008年12月重症监护病房(ICU)机械通气患者开展目标性监测,对80例有病原学诊断依据的VAP患者,分析其病原菌及耐药性。结果共检出致病菌107株,其中革兰阴性菌73株(68.2%),真菌22株(20.6%),革兰阳性菌12株(11.2%);革兰阴性菌中铜绿假单胞菌26株(24.3%)、肺炎克雷伯菌19株(17.8%)、鲍氏不动杆菌14株(13.1%)、嗜麦芽寡养单胞菌8株(7.5%)为主要致病菌;革兰阳性菌中金黄色葡萄球菌6株(5.6%)占主导地位;白色假丝酵母菌为真菌感染的主要致病菌;革兰阴性菌均出现较强的耐药性,铜绿假单胞菌仅对头孢他啶和碳青酶烯类药物敏感,肺炎克雷伯菌、鲍氏不动杆菌和大肠埃希菌对碳青酶烯类及阿米卡星药物敏感,嗜麦芽寡养单胞菌对碳青酶烯类药物及其他大多数药物耐药。结论 VAP的病原菌以革兰阴性菌占优势,铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌、嗜麦芽寡养单胞菌为ICU中VAP的主要致病菌;真菌感染的发生率不可忽视,致病菌耐药性升高,临床上应加强抗菌药物的合理应用。
OBJECTIVE To analyze the pathogens and drug-resistance of ventilator-associated pneumonia（VAP）patients in ICU for rational antibiotic therapy and the prevention of VAP.METHODS Pathogens and drug resistance in eighty ventilator-associated pneumonia cases with etiologically diagnostic evidences were analyzed.RESULTS From 107 strains of pathogens 73 strains（68.2%）were Gram-negative bacteria.22 strains（20.6%） of fungi and 12 strains（11.2%） of Gram-positives.In Gram-negative bacteria isolates,Pseudomonas aeruginosa（26 strains,24.3%） was the most common identified,followed by Klebsiella pneumoniae（19 strains,17.9%）,Acinetobacter baumannii（14 strains,13.1%）,and Stenotrophomonas maltophilia（8 strains,7.5%）;and in Gram-positives,Staphylococcus aureus（6 strains,5.6%） was the most commonly identified.Candida albicans was the major pathogen for fungal infections.The result of the antibiotic resistance monitoring indicated that Gram-negative bacteria all showed higher drug resistance to commonly used antibiotics.P.aeruginosa was susceptible to ceftazidime,carbapenems and amikacin.Mostly Klebsiella and Enterobacter were susceptible to carbapenems.S.maltophilia was drug-resistant to carbapenems and other antibacterial drugs.CONCLUSIONS In VAP pathogenic isolates,Gram-negative bacteria occupy the most.The most common VAP isolates in ICU are P.aeruginosa,K.pneumoniae,A.baumannii,and S.maltophilia,the incidence of fungi infection might not be ignored.The elevated antibiotic resistance of pathogens requires a rational clinical use of antibiotics.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2010年第15期2332-2334,共3页
Chinese Journal of Nosocomiology
关键词
呼吸机相关性肺炎
病原菌
耐药性
Ventilator-associated pneumonia
Pathogenic bacterium
Drug resistance
