ICU呼吸机相关性肺炎病原菌分布及多重耐药性研究.doc

ICU呼吸机相关性肺炎病原菌分布及多重耐药性研究[摘要] 目的 探讨ICU呼吸机相关性肺炎（ventilator-associated pneumonia，VAP）的病原菌分布及多重耐药性。方法 回顾性分析我院2007年8月～2010年6月ICU病房54例VAP患者的临床资料，了解其病原菌的构成及其药物敏感性。结果 共检出病原菌87株，其中革兰阴性（G-）杆菌占67.8%，革兰阳性（G+）球菌占23.0%，真菌占9.2%。铜绿假单胞杆菌最多（31.0%），其次为金黄色葡萄球菌（16.1%）和不动杆菌（14.9%）。G-杆菌对碳青霉烯类抗生素的耐药性较低（＜12%）；G+球菌中，未发现耐利奈唑胺和万古霉素的葡萄球菌。结论 ICU呼吸机相关性肺炎以G-杆菌为主，且呈多重耐药性，临床应重视病原菌的检测及敏感抗生素的使用。 [关键词] 呼吸机相关性肺炎（VAP）；病原菌；多重耐药性 [中图分类号] R446.5 [文献标识码] B[文章编号] 1673-9701（2011）21-115-02 The Research of Pathogenic Bacteria Distribution and Multi-drug Resistance of Ventilator-associated Pneumonia in ICU YAN Guangling ICU of the First People’s Hospital of Pinghu City，Zhejiang Province，Pinghu 314200，China [Abstract] Objective To investigate the pathogenic bacteria distribution and multi-drug resistance of ventilator-associated pneumonia（VAP）in intensive care unit（ICU）. Methods 54 cases of VAP in our hospital from 2007 to 2010 were analyzed retrospectively；the pathogens and antimicrobial susceptibility were detected. Results Among 87 strains of isolated pathogens，the gram-negative bacteria accounted for 67.8%，the gram-positive bacteria for 23.0%，and the fungi for 9.2%. The isolating rate of Pseudomonas aeruginosa was the highest 31.0% and then was Staphylococcus aurous and Acinetobacter（each for 16.1% and 14.9%）. Gram-negative bacillus showed low resistance to Carbopenems（＜12%）. Gram-positive coccobacteria was not found the strains can revisited the Vancomycin and Linezolid. Conclusion Gram-negative bacteria were the majority of the pathogens isolated from patients with ventilator-associated pneumonia in ICU. Clinical doctors should think highly of pathogen detection and rational application of antibiotics. [Key words] Ventilator-associated pneumonia；Pathogens；Multi-drug resistance 呼吸机相关性肺炎（ventilator-associated pneumonia，VAP）是指经气管插管或切开，行机械通气48h后或拔管后48h内所出现的肺部感染[1，2]，是机械通气的主要并发症之一，病死率高达33%～71%[3]。为有效治疗VAP，明确感染菌群的流行分布及耐药特点，我们回顾性分析了我院2007年8月～2010年6月我院ICU病房54例患VAP患者的病原菌分布及耐药性，为临床预防和治疗VAP提供参考。