广州地区呼吸机相关性肺炎临床流行病学和病原学分析

目的对广州地区呼吸机相关性肺炎（VAP）的临床流行病学、病原菌分布、耐药情况及预后进行临床病例研究，以期指导临床治疗。方法对2004年1月～2005年10月在广州市4家三级甲等医院发生VAP的157例患者进行临床病例的统计，对致病菌进行细菌鉴定，采用纸片扩散法检测其耐药性，采用单因素分析方法进行预后分析。结果VAP平均发病时间为机械通气后7．7d，总死亡率38．2％。革兰阴性细菌125株（68．0％），革兰阳性细菌43株（23．4％），真菌16株（8．7％）。铜绿假单胞菌（18．5％）、嗜麦芽窄食单胞菌（14．1％）、洋葱伯克霍尔德菌（10．9％）、金黄色葡萄球菌（10．3％）和鲍曼不动杆菌（8．7％）为VAP最常见的病原菌。铜绿假单胞菌、嗜麦芽窄食单胞菌和鲍曼不动杆菌对头孢菌素及亚胺培南等各种常见抗菌药物耐药率情况均十分严重。检出金黄色葡萄球菌19株，其中耐苯唑西林金黄色葡萄球菌（ORSA）检出率为94．7％（18／19）；检出溶血性葡萄球菌7株，全部耐苯唑西林；除替考拉宁、万古霉素和呋西地酸的耐药率较低外，对其他9种抗菌药物的耐药率均在50％以上；发现1株对万古霉素耐药的金黄色葡萄球菌。结论广州地区呼吸机相关性肺炎病原菌耐药严重，死亡率高，须加强预防及合理进行经验性抗生素治疗。

Epidemiological and etiological analysis of ventilator-associated pneumonia in Guangzhou area

Objective To analyze the clinical and etiological characteristics and bacterial susceptibility in patients with ventilator-associated pneumonia(VAP) in Guangzhou area.Methods A retrospective study was conducted on VAP patients in four hospital of Guangzhou from Jan 2004 to Oct 2005.Totally 157 patients were enrolled in this study,whose flora was identified and tested by Kirby Bauer disk diffusion susceptibility test.The univariate analysis method was used to analyze the prognostic parameters.Results The average onset time of VAP was 7.7 days after mechanical ventilation with a mortality rate of 38.2%.The proportion of Gram-negative bacilli,Gram-positive cocci and eumycete was 68.0%,23.4% and 8.7%,respectively in 184 isolated strains.The most common pathogens were Pseudomonas aeruginosa(18.5%),Stenotrophomonas maltophilia(14.1%),Burkholderia cepacia(10.9%),Staphylococcus aureus(10.3%) and Acinetobacter baumannii(8.7%).Pseudomonas aeruginosa,Stenotrophomonas maltophilia,and Acinetobacter baumannii were resistant to most common antibacterials including cephalosporin and imipenem.18 strains oxacillin resistant Staphylococcus aureus,7 strains oxacillin resistant Staphylococcus simulans and one vancomycin resistant Staphylococcus aureus were isolated.Expect for vancomycin,teicoplanin and fusidic acid,more than 50% Gram-positive cocci were resist to other 9 antibacterials.Conclusions The antibiotic resistance of VAP related pathogens in Guangzhou is very serious with high mortality.It is important to reinforce the prevention and treatment of VAP.