98例迟发性呼吸机相关性肺炎患者的病原学及耐药性监测.pdfVIP

98 例迟发性呼吸机相关性肺炎 患者的病原学及耐药性监测 屠越兴 俞云松 李茜 韩芳 江玲芝 【 摘要 】 目的 探讨迟发性呼吸机相关性肺炎（VAP）患者的病原菌分布和耐药性。 方法 将 98 例被确诊为迟发性 VAP 的机 械通气患者进行病原学分布和耐药状况监测 。结果 纤维支气管镜采样 98 例共检出致病菌 168 株，革兰阴性菌占 82.9% ，其中非发酵 菌占 50.2% ，肠杆菌科占 32.7% ；革兰阳性菌占 13.5% ；真菌占 4.6% 。 前 3 位致病菌分别为鲍氏不动杆菌（26.9% ）、铜绿假单胞菌 （13.6%）和肺炎克雷伯菌（10.5%）。药敏结果显示前几位革兰阴性菌对常用抗菌药物均有较高耐药性，革兰阳性菌均对万古霉素敏感。 结论 迟发性 VAP 的病原菌以革兰氏阴性菌为主，且呈现多重耐药现象，合适的经验性抗菌药物治疗应根据病原学与耐药性的监测 结果。 【 关键词 】 呼吸机相关性肺炎 抗生素 耐药性 纤维支气管镜 病原学 Pathogenesiss ands drugs resistances ins s 98s Patientss withs late- onsets ventilator- associateds pneumonias TU Yuexing, YU Yunsong, LI Qian，et al. Department of Infections Disease, Sir Run Run Shaw Affiliated Hospital，Zhej iang University School of Medcine, Hangzhou 310016, China 【Abstracts 】 Objective Tosprobesthespathogenesissandstheirsresistancestosantibioticssofslate- onsetssventilator- associatedss pneumonia (VAP).ss Methodss s As clinicals trials ins late- onsetss VAPs episodess ofs 98s patientss receivingss mechanicalss ventilation,s Thes pathogenesiss ands theirs resistances tos antibioticss weres analyed.s Resultss s As totals ofs 168s pathogens strainss weres isolateds throughss fiberbronchoscopysbysbacterialsculture,ThesGram- negativesbacteria (GNB)sweres82.9%,sNon- fermenterssweres51.4%sandsEnter- obacteriaceaesweres32.7%samongsits,ThesGram- positivesbacteriasweres13.5%,thesfungis4.6%.Thestopsthreespathogensstrainsswiths VAPsweresAcinetobactersbaumanii(26.9%),Pseudomonassaeruginosa(13.6%),Klebsiellaspneumoniae(10.5%)s.GNBswereshighlysre- sistants tos commons antimicrobialss ands demonstrateds multi- drugs resistance,s Drugs resistances ofss thes Gram- positives bacteriass tos vancomycinswassConclusions sThesmajorspathogenicsbacteriasinslate- onsetssVAPsissGNB,sandstheresaresoftensdemonstratedsmul- ti- drugsresistance,Itsisssuggestedsthatsempiricsantimicrobialstherapysforspatientsswithsl