呼吸机相关肺炎的病原菌分布及耐药监测临床分析

目的：探讨呼吸机相关性肺炎（VAP）的病原菌分布及其耐药性。方法：对呼吸科监护病房（RICU）使用呼吸机的32例患者进行目标性监测、病原学检查和细菌对抗生素耐药性结果进行回顾性分析。结果：32例患者检出98株致病菌，其中革兰阴性菌占69．39％（68／98），革兰阳性菌占21．43％（21／98），真菌占9．18％（9／981；革兰阴性菌中以铜绿假单胞菌（32．65％），肺炎克雷伯菌（16．33％），鲍曼不动杆菌（9．19％）为主要致病菌；革兰阳性菌中以金黄色葡萄球菌（14．29％）占主导地位；念珠菌属仍为真菌感染的主要致病菌；致病菌对常用抗菌药的耐药性普遍升高。结论：VAP的病原菌以革兰阴性菌占优势，铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌和鲍曼不动杆菌为RICU中VAP的主要致病菌，真菌感染的发生率不可忽视；致病菌耐药性升高，临床上应加强抗生素的合理使用。

Clinical study on categories of ventilator-associated pneumonia pathogens and their drug-resistance

Objective ：To examine the categories of ventilator-associated pneumonia（VAP） pathogens and their drug-resistance so as to provide evidence for clinical rational use of antibiotics.Methods： 32 patients hospitalized in respiratory intensive care unit receiving ventilator respiration treatment were targetedly monitored. The microbial sensitivity tests and antibiotic test results were retrospectively analyzed. Results：98 pathogens were isolated from 32 patients,Gram-negative bacteria occupying 69.39% （68/69） of the isolates, Gram-positive bacteria occupying 21.43% （21/98）, and fungi occupying 9.18% （9/98）. In Gram-negative bacteria isolates, Pseudomonas aeruginosa （32.65%） was the most commonly identified, followed by Klebsiella pneumoniae （16.33%） and Acinetobacter banmaunii （9.19%）; and in Gram-pesitive bacteria, Staphyloeocus aureus （14.29%） was the most commonly identified. Oidiomycetes were the major pathogens for fungi infections. The antibiotic resistance of the pathogens was increasingly higher. Conclusion：In VAP pathogenic isolates, Gram- negative bacteria occupied the most. The most common VAP isolates in RICU were Pseudomonas aeruginosa,KlebsieUa pneumoniae, Staphylococus aureus and Acinetobacter baumannii, the incidence of fungi infection mignt not be ignored. The elevated antibiotic resistance of pathogens required a rational clinical use of antibiotics.