呼吸机相关性肺炎患者病原菌分布及耐药情况的研究.docVIP

呼吸机相关性肺炎患者病原菌分布及耐药情况的研究 　　[摘要] 目的 探讨医院呼吸机相关性肺炎（VAP）病原菌分布及耐药情况，以便更好地指导临床用药。方法 回顾性分析我院收治的598例机械通气患者的临床资料，从中筛选VAP患者并对其下呼吸道分泌物病原菌进行培养并鉴定结果。结果 221例VAP患者下呼吸道痰液共分离出251株病原菌，其中革兰阴性菌与阳性菌分离率分别占71.3%与17.9%；革兰阴性菌与阳性菌分别以鲍曼不动杆菌与金黄色葡萄球菌分离率最高。鲍曼不动杆菌泛耐药菌株的检出率最高，达27.9%，MRSA和MRSE检出率分别为66.7%和61.5%。 结论 VAP的病原菌以革兰阴性菌为主，相关菌株耐药性逐渐增高，应及时监测相关病原菌耐药性。 　　[关键词] 呼吸机相关性肺炎；病原菌；耐药 　　[中图分类号] R446.5 [文献标识码] B [文章编号] 1673-9701（2014）23-0013-03 　　[Abstract] Objective To investigate the distribution and drug resistance pathogens from ventilator-associated pneumonia （VAP） patients for to better guide clinical treatment. Methods The medical records of 598 mechanical ventilation patients were retrospectively reviewed and the results of sputum culture and antibiotic resistance of pathogens from VAP patients were analyzed. Results The 251 strains of pathogens were isolated from lower respiratory tract sputum specimens in 221 patients with ventilator-associated pneumonia. Among them， the isolation rate of the gram-negative bacteria was the highest（71.3%）， followed by the gram-positive bacteria（17.9%）. The Acinetobacter baumannii and Staphylococcus were the top species in gram-negative and gram-positive bacteria， respectively. The isolation rate of the pan-resistant for Acinetobacter baumannii was 27.9% and the isolation rate of methicillin-resistant Staphylococcus aureus （MRSA） and methicillin-resistant Staphylococcus epidermidis （MRSE） were 66.7% and 61.5%， respectively. Conclusion The gram-negative bacteria remain dominant in the pathogens causing VAP， and related strains are highly drug resistant. It is crucial for timely monitoring of drug resistance of the pathogens. 　　[Key words] Ventilator-associated pneumonia；Pathogens；Antimicrobial resistance 　　目前临床上一些急危重症患者往往存在各种器官衰竭的情况，常需要机械通气的方法来维持患者呼吸功能[1]。由于急危重症患者免疫力低下，而机械通气患者在切开气道过程中使人体内环境与外界环境相互接触，使组织也受到一定损伤，最终导致呼吸机相关性肺炎（VAP）[2]。VAP的发病率高达40%～70%，病死率达15%～76%[3，4]，可能与病原菌耐药的流行密切相关[5-7]。本研究回顾性分析2009年1月～2013年12月我院收治的598例机械通气患者的临床资料，筛选出VAP患者并对其下呼吸道分泌物病原菌分布及耐药情况进