呼吸机相关性肺炎常见致病菌及其耐药性分析

目的：调查呼吸机相关性肺炎（VAP）患者菌群分布及耐药特点,为临床VAP防治提供可行性依据。方法：回顾分析54例呼吸机相关性肺炎患者的病原菌谱,耐药性及其临床特征。结果：VAP平均发病时间为机械通气后6.3 d,总病死率为44.4%,共分离出病原菌102株,其中革兰阴性菌80株（占78.4%）,革兰阳性菌18株（占17.6%）,真菌4株（占3.9%）。革兰阴性菌中占前3位的分别是肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌,革兰阳性菌主要是金黄色葡萄球菌,其中耐甲氧西林的金黄色葡萄球菌（MRSA）对万古霉素有100%的敏感性。结论：VAP的主要病原菌为革兰阴性杆菌,常为多重耐药的致病菌,为避免耐药率的升高,临床需合理使用抗生素。

Common Pathogens of Vent-associated Pneumonia and Their Drug Resistance

Objective： To investigate the bacterial spectrum of vent-associated pneumonia（VAP） and characteristics of drug resistance so as to provide evidences for clinical therapy.Methods： The bacterial spectrum from 54 patients in the Department of Respiratory Medicine and ICU from May 2007 to May 2008,the bacterial resistance to drugs and their clinical characteristics were analyzed retrospectively.Results： The average onset time of VAP was 6.3 days after mechanical ventilation with a mortality rate of 44.4%.A total of 102 strains of pathogens were identified of which 80（78.4%） were Gram-negative bacteria,18（17.6%） Gram-positive cocci and 4（3.9%） fungi.The top 3 Gram-negative bacteria were Klebsiella pneumoniae,Pseudomonas aeruginosa,and Escherichia coli.The main Gram-positive cocci were 11 strains of Staphyloccus aurens of which meticillin resistant S.aurens was 100% sensitive to vancomyc.Conclusion： VAP pathogens are mainly Gram-negative bacteria and have multiple resistance to drugs.In order to avoid the increase of drug resistance,reasonable application of antibiotics should be emphasized.