ICU内呼吸机相关性肺炎的病原菌及耐药性分析

目的：分析重症监护室（ICU）呼吸机相关性肺炎（VAP）的病原菌分布及耐药情况。方法：分析2007年1月～2008年12月在重症监护室发生VAP的患者资料，对其病原菌分布及耐药情况进行汇总。结果：63例VAP患者中共检出138株致病菌，其中革兰阴性菌（G^-）67．4％，革兰阳性菌（G^＋）12．3％，真菌20．3％。大多数G^-菌对常用的抗菌药已表现出较高的耐药性。金黄色葡萄球菌耐药性严重，对苯唑西林的耐药率达92．9％，但对万古霉素、利奈唑烷均敏感。结论：VAP的病原菌以G^-杆菌占优势，并且致病菌呈多重耐药性。在采取经验性治疗时，应选择对常见致病菌有较好覆盖率且耐药率低的抗生素，并重视病原菌的检查，指导合理使用抗生素。

Analysis for the pathogens and drug resistance of VAP in ICU

Objective: To analyze the pathogens and the drug-resistance of ventilator-associated pneumonia (VAP) in ICU. Methods: Among 63 patients with VAP in intensive care unit (ICU) in our hospital between Jan 2007 and Dec 2008, pathogens distribution and drug-resistance rate were analyzed. Results: Totally 138 pathogens were cultivated altogether in all 63 VAP patients. Among the pathogens, the Gram-negative bacteria(GNB)accounted for 67.4%, the Gram-positive bac-teria(GPB) for 12.3%, and the fungi for 20.3%. Most of the GNB showed high resistance rote to common used antibiotics. Staphylococns anrens had severe drug-resistance to oxacillin but it was still highly susceptible to vancomycin and linezoid. Conclusion: GNB is still the major pathogens of VAP. Multi--drug--resistance (MDR) could be occurred in most of the pathogens. Given the possible multiple drug resistance of pathogen, appropriate antibiotics with low drug resistance of potential should be empirically used against infection. Pathogen test prior to or concurrent with anti-microbiological therapy is important in guiding the reasonable application of antibiotics.