呼吸机相关性肺炎的病原菌分布和耐药性分析

目的:探讨我院呼吸机相关性肺炎(VAP)患者的致病菌分布特点和耐药特性,指导临床用药。方法:回顾分析2015年3月~2017年3月我院各ICU呼吸机相关性肺炎患者痰培养及药敏试验结果。结果:71例VAP患者痰培养共检出220株致病菌,革兰氏阴性杆菌189株占大部分(85.7%),其中以铜绿假单胞菌(20.9%)居首位,鲍曼不动杆菌(17.7%)次之,嗜麦芽窄食单胞菌(16.4%),肺炎克雷伯菌(14.5%)、洋葱伯克霍尔德菌(14.1%)分别位列第三、四、五位,总体耐药性较高,鲍曼不动杆菌及肺炎克雷伯氏菌均出现了泛耐药菌;耐甲氧西林金黄色葡萄球菌(MRSA,3.6%)占据革兰氏阳性菌的主要部分,真菌以念珠菌为主,占10%。结论:革兰氏阴性杆菌占据我院ICU VAP病原菌主要部分,多重耐药严重,动态监测患者病原菌分布特点和耐药特性有利于VAP的控制。

Monitoring on Distribution and Drug Resistance of Ventilator-associated Pneumonia Pathogens

Objective:To explore the distribution and drug resistance of the pathogens ventilator-associated pneumonia (VAP) in our hospital for guiding clinical medication.Methods:The results of sputum culture and drug susceptibility of patients with VAP in our ICUs from March 2015 to March 2017 were reviewed in the study.Results:A total of 220 pathogenic bacteria were detected in 71 patients with VAP,most of which were 189 strains of gram-negative bacillus (85.7％).Among them,pseudomonas aeruginosa (20.9％) ranked the first,acinetobacter baumannii (17.7％) ranked the second,Sphingomonas paucimobilis (16.4％),klebsiella pneumoniae (14.5％),and oniobacteria (14.1％) ranked the third,fourth and fifth respectively,and most of them showed strong drug resistance.Both acinetobacter baumannii and klebsiella pneumoniae showed drug-resistant bacteria;methicillin-resistant staphylococcus aureus (MRSA,3.6％) occupied a major part of gram-positive bacteria,the fungus were mainly moniliformes,accounting for 10％.Conclusion:Gram-negative bacteria is the main pathogen of VAP in ICUs,whose multi-drug resistance is serious.Dynamic monitoring on the characteristics of its distribution and drug resistance could be helpful for the treatment of ventilator-associated pneumonia.