摘要
目的探讨呼吸机相关肺炎（VAP）的病原菌分布和细菌耐药特点,为临床合理使用抗生素提供参考。方法收集2010年1月~2011年12月中国医科大学附属盛京医院呼吸内科MICU病房进行有创机械通气的患者130例,对其中发生VAP的患者致病菌及耐药性情况进行调查。结果 130例有创机械通气患者中,机械通气时间大于48 h的患者103人,发生VAP的48人。随着机械通气时间的延长,发生VAP的患者例数及分离出的致病菌株明显增加。共检出病原菌79株（剔除重复菌株）,G-菌68株（86.1%）以鲍曼不动杆菌（53.16%）及铜绿假单胞菌（26.58%）检出率最高;G＋菌3株（3.8%）,均为金黄色葡萄球菌;真菌8株（10.1%）。两种以上致病菌混合感染17例（35.4%）。结论目前VAP的病原菌仍以鲍曼不动杆菌及铜绿假单胞菌等革兰氏阴性杆菌为主,细菌耐药率较高,VAP的发生率与呼吸机使用时间有关。
【Objective】To investigate the traits of pathogens and the drug-resistance of VAP, in order to provide a reference for the clinical treatment about reasonable use of antibiotics.【Methods】130 cases datum about the pa- tients who were operated on invasive mechanical ventilation in the MICU in Shengjing Hospital of China Medical U- niversity were collected during the period of January 2010 to December 2011, and investigated the situation of pathogens and drug resistance about patients who had acquired VAP.【Results】In 130 cases of injured mechanical ventilation, 103 patients are mechanically ventilated in more than 48 hours,and 48 patients have the occurrence of VAP. The number of the patients who had acquired VAP and the number of the pathogenic strain that separated from the sputum specimens significantly increased as the extension of the duration of mechanical ventilation. 79 strains of pathogenic bacterium are detected（eliminate repeated strains）, including 68 strains of gram-negative bacte- ria（86.1%）, 3 strains of Gram-positive（3.8%）, and 8 strains of Fungi（10.1%）. 17 cases of mixed infection with two or more kinds of pathogenic bacteria（35.4%）. The pathogenic strains of the first two detected rate are acinetobacter baumannii（53.16%） and pseudomonas aeruginosa（26.58%）. The 3 strains of gram-positive（3.8%） are all staphylo- coccus aureus. 【Conclusions】At present, the bacterium causing the disease of VAP still are gram-negative bacilli such as acinetobacter baumannii and pseudomonas aeruginosa which have a rather high drug resistance. The inci- dence rate of VAP related with the using time of mechanical ventilation.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2013年第33期61-65,共5页
China Journal of Modern Medicine
关键词
呼吸机相关肺炎
医院感染
病原菌
细菌耐药性
ventilator-associated pneumonia
hospital infection
pathogens
drug-resistance
