呼吸机相关性肺炎病原菌的变化及耐药性分析

目的 分析医院重症医学科、呼吸科、脑外科、神经内科等科室呼吸机相关性肺炎(VAP)病原菌的变化及耐药性趋势,为临床治疗和控制医院感染提供依据.方法 收集医院2009-2010年住院患者呼吸道分泌物标本,分析病原菌的分布和耐药性.结果 4464份呼吸道标本中分离出病原菌2451株,占54.9％,其中以革兰阴性杆菌为主,占67.3％,位列前5位依次为肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌、大肠埃希菌、阴沟肠杆菌；革兰阳性菌占13.2％,位居前2位是缓症链球菌、金黄色葡萄球菌；真菌占19.5％,以白色假丝酵母菌为主;碳青霉烯类、头孢哌酮/舒巴坦等抗菌药物对革兰阴性杆菌作用最强；对非发酵菌头孢哌酮/舒巴坦等更有优势;万古霉素对革兰阳性球菌高度敏感,其他抗菌药物均存在不同程度的耐药.结论 革兰阴性杆菌是VIP的主要致病菌,且病原菌的种类和耐药性在不断地发生变化,应根据微生物实验室检测合理用药,以抑制细菌耐药性的发展并提高感染性疾病的治疗效果.

Change of pathogenic bacteria causing ventilator-associated pulmonary infection and analysis of drug resistance

OBJECTIVE To analyze the change of pathogenic bacteria causing ventilator-associated pulmonary infection in critical care medicine department,respiratory department,cerebral surgery department and neurology department and the characteristics of drug resistance,so as to provide reference for the management and treatment of nosocomial infections.METHODS The secretion samples from respiratory tracts from 2009 to 2010 were collected.The distribution and drug resistance of the pathogens were analyzed.RESULTS Totally 2451 strains of pathogenic bacteria were isolated from 4464 respiratory tract specimens,accounting for 54.9%,among which gram-negative bacilli were predominant,accounting for 67.3%.The top 5 gram-negative bacilli were Klebsiella pneumonia,Acinetobacter baumannii,Pseudomonas aeruginosa,Escherichia coli and Enterobcter cloacac.Gram-positive cocci accounted for 13.2%.Streptococcus mitis and Staphylococcus aureus were the top 2 gram-positive cocci.Fungi accounted for 19.5% and Candida albicans was the most common.According to drug susceptibility results,gram-negative bacilli were susceptible to carbapenems and cefopcrazone/sulbactam.Nonfermenting bacteria were more susceptible to cefopcrazone/sulbactam;gram-positive cocci were highly susceptible to vancomycin and had different degrees of resistance to other antibiotics.CONCLUSION Gram-negative bacilli are the predominant pathogens in VAP,but there are always some changes in categories and drug resistance.We ought to reasonably select antibacterial drugs based on results gained through the laboratory tests,so as to restrain the development of bacterial resistance and improve the therapeutic effect for infectious diseases.