重症监护病房中呼吸机相关肺炎的病原学和耐药性特征

目的探讨重症监护病房（ICU）中呼吸机相关肺炎（VAP）的流行病学、病原菌分布、耐药性特征。方法对广州市3所三级甲等医院ICU发生VAP的53例患者进行前瞻性研究，对病原菌进行细菌鉴定和耐药性分析。结果VAP平均发病时间为机械通气后7．8d。97株病原菌中革兰阴性细菌58株（59．8％），革兰阳性细菌23株（23．7％），真菌16株（16．5％）。最常见病原菌分别为铜绿假单胞菌16株（16．5％），金黄色葡萄球菌13株（13．4％），嗜麦芽窄食单胞菌8株（8．2％），肺炎克雷伯菌8株（8．2％），白色念珠菌8株（8．2％）。耐甲氧西林金黄色葡萄球菌（MRSA）检出率为100．0％；未发现耐万古霉素金黄色葡萄球菌；VAP病原菌存在严重的多重耐药性。结论ICU中VAP的病原菌构成以革兰氏阴性杆菌为主且呈现多重耐药现象，适当的经验性抗菌治疗应以病原学和耐药性的监测结果为依据。

Pathogenesis and Drug Resistance in Patients with Ventilator-Associated Pneumonia in ICU

Objective To probe the etiological characteristics and bacterial susceptibility on the patients with ventilator-associated pneumonia （VAP） in ICU. Methods A prospective clinical trial was conducted on 53 VAP patients in three hospitals of Guangzhou. The pathogens and their drug resistance were analyzed. Results The average onset time of VAP was 7.8 days after mechanical ventilation. The proportion of Gram-negative bacilli, Gram-positive bacilli and fungus was 59.8%,23.7% and 16.5%, respectively in 97 isolated strains. The most common pathogens associated with VAP were Pseudomonas aeruginosa （16.5%）,Staphylococcus aureus （13.4% ） ,Stenotropomonas maltophilia （8.2%）, Klebsiella pneumoniae （8.2%） and Candida albicans （8.2%）. Their multiple drug-resistance to antibiotics was serious. All Staphylococcus aureus strains were methicillin resistant, but sensitive to vancomycin. Conclusion The major pathogens in VAP are GNB and there are often multiple drug-resistant in ICU. It suggested that the adequate initial empiric antimicrobial treatment should be based on the surveillance of etiology and drug-resistance.