重症监护病房呼吸机相关性肺炎的病原菌种类分布和革兰阴性杆菌的耐药性分析

目的分析我院重症监护病房(ICU)患者呼吸机相关性肺炎(VAP)的病原菌分布及耐药情况。方法回顾我院ICU病房2009年7月～2011年2月使用有创机械通气患者中出现VAP的临床资料,统计分析病原菌分布和药敏结果。结果本组共分离出致病菌316株,其中革兰阴性杆菌(G-)213株(67.4%),革兰阳性杆菌(G+)91株(28.8%),真菌12株(3.8%)。VAP患者呼吸道分泌物中病原菌以革兰阴性杆菌为主,主要病原菌以铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌为主,检出率分别为24.1%、17.4%、11.7%。主要病原菌对阿米卡星、环丙沙星、庆大霉素、妥布霉素、头孢噻吩、头孢他啶、哌拉西林均有较高的耐药性,而且均存在严重的多重耐药性。结论我院综合ICU病房VAP患者的主要病原菌为革兰氏阴性杆菌,应加强对有创机械通气患者下呼吸道分泌物的病原学和耐药性的监测,临床分离细菌的耐药性较强,经验性抗感染治疗应覆盖耐药菌。临床工作者应在本地病原学监测和耐药性分析的指导下使用抗生素。

Analysis of distribution of pathogens and antibiotic resistance of gram-negative bacilli for ventilator-associated pneumonia in intensive care unit

Objective To investigate the distribution of pathogens and antibiotic resistance of gram-negative bacilli for ventilator-associated pneumonia(VAP) in intensive care unit(ICU),and provide a reference for clinical diagnosis and treatment of VAP in ICU.Methods The clinical data of patients of VAP in ICU was retrospectively analyzed from July 2009 to February 2011.The distribution of pathogens and drug resistance of gram-negative bacilli were analyzed.Results 316 pathogens were isolated,including gram-negative bacteria(G-) 213 strains(67.4%),Gram-positive bacteria(G+) 91 strains(28.8%),fungi 12 strains(3.8%).Th VAP pathogens in respiratory secretions was mainly gram-negative bacteria,the main pathogen included pseudomonas aeruginosa,klebsiella pneumoniae and escherichia coli-based,the detection rates were 24.1%,17.4% and 11.7%.The main pathogen had higher antibiotic resistance to the amikacin,ciprofloxacin,gentamicin,tobramycin,cephalothin,ceftazidime and Gua La Xilin,but there are serious multi-drug resistance.Conclusion The main pathogen of hospital ICU VAP is Gram-negative bacilli,it was neccesary to monitor pathogens and antibiotic resistance.Clinicians should apply antibiotics under the guidance of the local pathogen monitoring and analysis of drug resistance to antibiotics.