ICU呼吸机相关性肺炎病原菌的构成及耐药性分析

目的；分析医院综合ICU呼吸机相关性肺炎（VAP）病原菌的分布特点及其耐药性。为vAP治疗提供合理用药参考。方法：回顾性分析210例VAP患者的下呼吸道分泌物细菌培养及药敏结果。结果：210例VAP患者下呼吸道分泌物培养如瘸原菌394株．革兰阴性杆菌占784％．革兰阳性球菌占12.6％．真菌感染9．0％：各类病原燕混台感染者占83．8％：常见病原菌为鲍曼不动杆菌20，3％，铜绿假单胞菌188％。肺炎克雷伯菌16．2％，金黄色葡萄菌8，1％，耐甲氧西林金黄色葡萄球菌（MRSA）检出率87．5％，白色念珠菌7．6％。鲍曼不动杆菌仅对头孢碾酮／舒巴坦敏感，铜绿假单胞菌仅对头孢哌酮／舒巴垣和碳膏酶烯类药物敏感，肺炎克雷伯菌和大肠埃希菌对碳青酶烯类药物敏感，金黄色葡萄球菊耐药现象严重．对万古霉素和替考拉宁敏感，白色念珠菌对氟康唑、伊曲康瞪、伏立康唑敏感。结论：VAP的主要瘸原菌以革兰阴性杆菌为主，耐药现象严鬣．多数为混合感染。治疗困难。进行细菌培养和药物敏感性试验．对合理选用抗菌药物治疗VAP具有重要意义。

Distribution and Drug-resistance of Pathogens in Patients with Ventilatorassociated Pneumonia in ICU

Objective： To determine the distribution and drug resistance characteristic of pathogens in patients with ventilator-associated pneumonia （VAP） and direct clinical doctors to select antibiotics correctly. Methods： The secretion of lower respiratory tract of 210 patients received tracheostomy and mechanical ventilation for more than 48 hours was cultured with a quantitative method and their antibiotic susceptibility was detected. Results： Gram-negative bacilli （GNB） were the main pathogens in VAE Among 394 strains of pathogens collected, the GNB occupied 78.4%, the Gram-positive bacteria （GPB） were 12.6 %, and the fungi were 9.0%. The mixed infections attained to 83.8 %. Pseudomonas aeruginosa was susceptible to ceftazidime and carbopenems .Mostly Klebsiella were susceptible to carbopenems. Staphylococcus aureus was still highly susceptible to vancomycin. Conclusion： GNB are still the most important pathogens in VAP and have multiple drug-resistances. Mixed infections are severe, bacterial culture and antibiotic susceptibility tests are very important to select antibiotics correctly for treatment of VAP.