呼吸机相关性肺炎患者细菌病原的对比研究

目的 探讨呼吸机相关性肺炎患者细菌病原特点.方法 选取确诊呼吸机相关性肺炎的患者85例为研究对象,将所获下呼吸道分泌物为标本,留标本一分为二,一份于30分钟内行分离培养加药敏检测；另一份置-80℃冰箱保存,集中进行多重PCR检测.采用多重PCR方法检测5种呼吸机相关性肺炎常见细菌病原菌的阳性率及分布情况.结果 常规分离培养呼吸机相关性肺炎患者检出21株致病菌,阳性率为24.7％（21/85）,G-菌占85.7％（18/21）；多重PCR检测呼吸机相关性肺炎患者检出69株致病菌,阳性率为81.2％ （69/85）,G-菌占89.9％（62/69）.标本采集前有71.7％（61/85）的患者采用了抗生素治疗,分离培养阳性率为11.5％（7/61）,多重PCR阳性率为80.3％（49/61）.结论 呼吸机相关性肺炎患者下气道感染病原以革兰氏阴性菌为主；多重PCR检测的阳性率高于分离培养,这在已使用抗生素治疗的患者中尤为有效,可以作为分离培养的有利补充.

Contrastive Study of Pathogens in Patients with Ventilator-associated Pneumonia

Objective In order to study the pathogen distribution of lower respiratory tract of adult ICU ventilator- associated pneumonia（ VAP） patients and discuss the diagnostic value of multiplex PCR in bacterial pathogens of VA P patients, secretion of lower respiratotract was isolated and detected by multiplex PCR. Methods 85 samples of low- er respiratory tract secretion from diagnosed VAP patients in ICU ward were collected, and each sample was divided to two, so all the samples were seperated into two parts. One part were sent to laboratory room to isolate and culture bacteria and test drug sensitivity in 30 minutes. Another part samples were saved in -80 ~（7 refrigerator, and then were tested by multiplex PCR. The positive rate and the distribution of 5 kinds of common bacterial pathogens （Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, A cinetobacter baumannii） in VA P were analyzed. Re- sults Conventional isolation and culture were used, and 21 strains of pathogenic bacteria were detected in VA P patients. The positive rate was 24.7% （21/85）,and Gram-negtive bacteria positive rate was 85. 7% （18/21）. 69 strains of pathogen- ic bacteria were detected positive in VAP patients using multiplex PCR.The positive rate was 81.2% （69/85）, and Gram- negtive bacteria positive rate was 89.9%（62/69）. 71.7% （61/85） patients with VAP were treated with antibiotics before sample collection, the positive rate of isolation and culture was 11.5% （7/61）, while the positive rate of multi plex PCR was 80.3% （49/61）. Conclusions Both bacteria culture and multiplex PCR detection secretions of VAP patients lower re- spiratory tract are mainly gram-negtive bacteric4 and the pathogenic bacteria positive rate of multi plex PCR is higher than that of isolation and culture, especially in the pretreated with antibiotics. Therefore, multiplex PCR can be used as the sup＋ plement of isolation and culture.