ICU呼吸机相关性肺炎的病原菌分布及耐药性分析

目的分析本地区ICU呼吸机相关性肺炎（VAP）的病原菌分布及耐药性特点,更好的指导临床抗菌药物的应用。方法回顾性分析ICU收治的机械通气〉48h的573例患者的资料,对下呼吸道分泌物进行细菌培养、分离和鉴定,药敏试验采用K-B纸片扩散法。结果 573例患者中发生VAP 118例,VAP发生率为20.59%。118例患者中共分离出125株病原菌,包括革兰阴性菌97株,占77.6%,革兰阳性菌23株,占18.4%,真菌5株,占4.0%。分布最多的三种细菌为铜绿假单胞菌、鲍曼不动杆菌和金黄色葡萄球菌,分别占22.4%、20.0%和15.2%。常见革兰阴性菌铜绿假单胞菌和鲍曼不动杆菌表现出多重耐药性。结论本地区ICU发生的VAP以革兰阴性菌感染为主,致病菌主要为铜绿假单胞菌和鲍曼不动杆菌,呈现出多重耐药性,临床在经验性治疗过程中,可根据药敏结果进行选择合理的抗菌药物。

Clinical analysis of the pathogens and drug resistance of ventilator associated pneumonia in ICU

Objective To analyze the the pathogens and drug resistance of ventilator associated pneumonia（VAP） in ICU,in order to guide the clinical application of antimicrobial agents. Methods 573 cases who maintained mechanical ventilation for longer than 48 h in ICU were collected in the study.The lower respiratory tract secretions were cultivated,separated and identificated,and the drug sensitive test was done by the K-B disc diffusion method. Resluts The VAP were found in 118 cases,and the incidence of VAP was 20.59%.A total of 125 strains of pathogens were isolated,including 97 strains of Gram-negative bacteria,23 strains of Gram-positive bacteria and 5 strains of fungi,accounted for 77.6%,18.4% and 4.0%.The three most common bacteria were Pseudomonas aeruginosa,Acinetobacter baumannii,and Staphylococcus aureus,accounted for 22.4%,20.0% and 15.2%.The Pseudomonas aeruginosa and Acinetobacter baumannii both showed the multiple drug resistance. Conclusion VAP in ICU in our region mainly infected by Gram-negative bacteria,of which Pseudomonas aeruginosa and Acinetobacter baumannii were the most common,presenting the multiple drug resistance.We should choose reasonable antimicrobial agents according to medicine results in empiric treatment process.