呼吸机相关肺炎病原学及药敏分析

目的分析呼吸机相关性肺炎(VAP)的病原学及药物敏感性,以指导经验性抗生素的使用。方法回顾分析2002年4月到2006午6月急诊ICU收治的61例合并VAP机械通气患者的致病菌分布及药敏情况。结果共检出致病菌161件,革兰氏阴性细菌占60．9%；前4位致病菌分别为铜绿假单胞菌(19．3%)、金黄色葡萄球菌(18．6%)、鲍氏不动杆菌(9．9%)和肺炎克雷伯菌(8．1%)；药敏结果显示这几类菌株的多重耐药现象严重,较为敏感的抗菌药物有亚胺培南、头孢他啶、头孢哌酮/舒巴坦、环丙沙星等,革兰氏阳性细菌均对万古霉素敏感。结论VAP的病原菌构成以革兰阴性细菌为主且呈现出多重耐药现象,经验性抗菌治疗应依据于当地的病原学流行情况,并根据药敏结果进行变化。

Pathogenesis and drug resistance in patients with ventilator-associated pneumonia

Objective To analyse the pathogenesis of ventilator-associated pneumonia (VAP) and their resistance to antibiotics.Methods A retrospective clinical study in 61 patients with VAP was carried out.The pathogens and their drug resistance were analyzed.Results A total of 161 pathogen strains were isolated identified by bacterial culture.The major pathogenic bacteria in VAP was the Gram-negative bacilli (GNB,60.9%).Among pathogens,the most common pathogens associated with VAP were Pseudomonas aemginosa (19.3%),Staphylococcus aureus (18.6%),Acinetobacter baumanii (9.9%),and Klebsiella pneumoniae (8.1% ).Their multiple drag-resistance to antibiotics was serious.Drug sensitivity tests indicated that the GNB had lower drug-resistance to imipenem.Conclusion The major pathogens in VAP were GNB and there were often multiple drug-resistant.