新建综合性ICU呼吸机相关性肺炎病原菌分析

目的了解新建综合性重症监护病房(ICU)中呼吸机相关性肺炎(VAP)病原菌的分布及耐药性特点,为临床用药提供参考资料。方法对2005年9月-2007年1月确诊VAP患者分离到的病原菌进行鉴定,并采用纸片扩散法进行药物敏感试验。结果VAP病原菌中革兰阴性菌为主,占70.5%,革兰阳性菌其次占24.6%,真菌占4.9%;位于前5位的病原菌依次为铜绿假单胞菌、金黄色葡萄球菌、鲍氏不动杆菌、大肠埃希菌、嗜麦芽寡养单胞菌;亚胺培南、美罗培南对主要的革兰阴性菌具有相对较好的敏感性,哌拉西林/他唑巴坦对铜绿假单胞菌有较好的敏感性;革兰阳性菌主要为MRSA,成为VAP病原菌的第2位,对万古霉素100.0%敏感。结论革兰阴性杆菌仍是新建ICU导致VAP的主要病原菌,且对多种抗菌药物耐药,MRSA成为VAP第2位的病原菌。

Pathogenic Bacteria of VAP in New Intensive Care Unit

OBJECTIVE To investigate the distribution and drug resistance of pathogenic bacteria in our new intensive care unit(ICU).METHODS Antimicrobial susceptibility of pathogenic bacteria isolated from ventilator-associated pneumonia(VAP) patients from Sep 2005 to Jan 2007 was performed by Kirby-Bauer method.RESULTS The main pathogens of VAP were Gram-negative bacilli(70.5%),the second were Gram-positive organisms(24.6%),the third were fungi(4.9%).The most common pathogens were Staphylococcus aureus,Acinetobacter baumannii,Escherichia coli,and Stenotrophomonas maltophilia.Imipenem and meropenem had the better antimicrobial susceptibility to Gram-negative bacilli.Piperacillin/tazobactam had the better antimicrobial susceptibility to Pseudomonas aeruginosa.The main pathogenic Gram-positive organism was meticillin-resistant S.aureus(MRSA).All strains of MRSA were antimicrobial sensitive to vancomycin.CONCLUSIONS Gram-negative bacilli are the main pathogenic bacteria of VAP,they are highly resistant to the most antimicrobial agents.MRSA is the next pathogen of VAP.