ICU呼吸机相关性肺炎病原学及药敏学研究

目的：明确ICU呼吸机相关性肺炎（VAP）的病原学及药敏学特点，指导合理用药。方法：对确诊的140例ICU内VAP患者的下呼吸道分泌物进行细菌培养鉴定及药敏试验。结果：140例VAP患者下呼吸道分泌物共培养出病原菌402株，其中G－菌295株（73．38％），G^＋菌59株（14．68％），真菌48株（11．94％）。排在前5位的G^-菌分别是铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌和嗜麦芽寡养单胞菌。分离所得的铜绿假单胞菌对亚胺培南、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦、头孢他啶和阿米卡星的耐药率〈30％；肺炎克雷伯菌和大肠埃希菌对亚胺培南、头孢哌酮／舒巴坦和哌拉西林／他唑巴坦的耐药率〈30％；鲍曼不动杆菌除亚胺培南、头孢哌酮／舒巴坦和哌拉西林／他唑巴坦外，对其他药物的耐药率均〉50％；嗜麦芽寡养单胞菌对头孢哌酮／舒巴坦和复方磺胺甲嗯唑的耐药率较低（分别为27．6％和34．5％），对其他药物的耐药率均〉70％。59株G^＋菌中主要以金黄色葡萄球菌和表皮葡萄球菌为主，耐药性严重，但对万古霉素和替考拉宁的敏感率均为100％。结论：VAP患者的主要病原菌为G^-且存在较严重的耐药现象，混合感染现象严重，进行细菌培养和药物敏感性分析对合理选用抗菌药物治疗VAP患者具有重要意义。

Study on Etiology and Drug Sensitivity Test of Ventilator-associated Pneumonia in ICU

Objective： To investigate the etiology and drug sensitivity test of Ventilator-associated Pneumonia in ICU, so as to provide rational use of antibiotic. Method ： One hundred and foity patients who were identified as VAP in ICU were selected. The germieulture and sensitivity test of specimens of the lower respiratory secretions were performed in all patients. Result ： Four hundreds and two pathogenic strains were detected from the specimens of the 140 VAP patients, including 295 Gram-negative bacilli （accounted for 73.38% ） ,59 Gram-positive bacilli （ 14.68% ） ,48 fungi （ 11.94% ）. The top five of Gram-negative bacilli were Pseudomonas aeruginose, Escherichia coli, klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas maltophilia. The isolated pseudomonas aeruginosa showed less than 30% resistant rate to imipenem, Cefoperazone/sulbactmn, Piperacillin/Tazobactam, eeftazidime and amikacin; The klebsiella pneumoniae showed less than 30% resistant rate to imipenem, Cefoperazone/sulbactam, and Piperacillin/Tazobactam; The Acinetobacter baumannii showed sensitive to imipenem, Cefoperazone/sulbactam and Piperaeillin/Tazobactam, and showed more than 50% resistant rate to other antibiotic. The Pseudomonas mahophilia showed low resistant rate to Cefoperazone/sulbactam and bactrim （27.6% and 34. 5% ,respectively） , and high resistant rate to other antibiotic （ more than 70% ）. The major strains of the 59 Gram- positive bacilli were staphylococcus aureus and staphylococcus epidennidis,showed severe drug resistance, and showed 100% sensitive rate to vancocin and teicoplanin. Conclusion： The major pathogenic bacteria of VAP patients was Gram-negative bacilli ,which showed severe drug resistance and polyinfection. Making the gennicuhure and drug sensitivity test will help the rational use of antibiotic on VAP patients.