肿瘤患者呼吸机相关性肺炎的病原菌及耐药性分析

目的明确重症监护病房（ICU）肿瘤患者呼吸机相关性肺炎（VAP）病原菌的分布和耐药性,指导临床合理用药。方法对ICU发生VAP的96例肿瘤患者的下呼吸道分泌物,进行细菌培养和药物敏感性测定。结果从96例VAP肿瘤患者下呼吸道分泌物标本中分离出172株病原菌,革兰阴性菌（G^-菌）占67.4%,主要是铜绿假单胞菌（30.2%）、鲍曼不动杆菌（12.8%）和大肠埃希氏菌（11.1%）,革兰阳性菌（G^＋菌）占24.4%,主要是金黄色葡萄球菌（12.2%）和表皮葡萄球菌（7.6%）,真菌占8.2%;混合感染者88例占91.7%;大多数G^-菌表现为多重耐药,大多数G^＋菌仅对万古霉素、替考拉宁和利奈唑胺敏感。结论 G^-菌是ICU肿瘤患者发生VAP的主要致病菌,耐药现象严重;G^＋菌绝大多数是耐甲氧西林菌株,对多数抗菌药物耐药;患者多为混合性感染。临床医生应根据细菌学培养和药敏结果,合理选择抗菌药物,对预防和减少VAP的发生、减少细菌耐药具有重要意义。

Distribution and Antibiotic Resistance of Pathogens in Tumor Patients with Ventilator- associated Pneumonia

Objective To investigate the distribution and antibiotic resistance of pathogens in tumor patients with ventilator-associated pneumonia（VAP） in intensive care unit（ICU）,and to direct clinical doctors to select antibiotics correctly.Methods The secretion of lower respiratory tracts of 96 tumor patients with VAP was cultured and their antibiotic susceptibility was detected.Results Totally 172 pathogens were isolated from secretion of lower respiratory tracts of 96 tumor patients with VAP,the Gram-negative bacilli（GNB） occupied 67.4%,the Gram-positive bacteria（GPB） occupied 24.4%,and the fungi were 8.2%.The mixed infections attained to 88（91.7%）.The main GNB were Pseudomonas aeruginosa（30.2%）,Acinetobacter baumanii（12.8%） and Escherichia coli（11.1%）;and have multiple antibiotic resistance.The most GPB were Staphylococcus aureus（12.2%） and Staphylococcus epidermidis（7.6%） and were highly susceptible to vancomycin,teicoplanin and linezolid.Conclusion GNB are still the most pathogens in tumor patients with VAP in ICU and have multiple antibiotic resistance.most GPB were methicillin-resistant.The mixed infections were high.Bacterial culture and antibiotic susceptibility tests were very important to select antibiotics correctly for VAP.