重症监护病房呼吸机相关性肺炎与非呼吸机相关性肺炎病原菌及耐药性的分析比较

目的：探讨重症监护病房（ICU）呼吸机相关性肺炎与非呼吸机相关性肺炎病原菌分布及耐药性，为 ICU 医师更加合理地使用抗菌药物提供依据。方法回顾性分析2012年1月至2013年12月我院的 ICU 患者送检的痰液和灌洗液标本，采用方法进行细菌培养及药敏试验，进行统计学分析。结果呼吸机相关性肺炎检出的前3位致病菌依次为鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌，分别占26.68％、18.47％、14.08％；非呼吸机相关性肺炎检出病原菌前3位依次为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌，分别占24.38％、21.55％、15.9％。两组间鲍曼不动杆菌和肺炎克雷伯菌的检出率存在统计学差异（P＜0.01），铜绿假单胞菌和大肠埃希菌的检出率两组间无明显差异。呼吸机相关性肺炎患者分离出的主要致病菌普遍比非呼吸机相关性肺炎患者的耐药率高。结论 ICU 呼吸机相关性肺炎与非呼吸机相关性肺炎病原菌构成及耐药性均有所不同，ICU 医师熟悉及掌握本科室的病原菌构成及耐药性情况，在药敏试验结果出来以前，对抗菌药物的使用有一定的指导意义。

Analysis of bacterial distribution and drug resistance between ventilator associated pneumonia and non-ventilator associated pneumonia in Intensive care unit

Objective To investigate bacterial distribution and drug resistance between ventilator associated pneumonia and non‐ventilator associated pneumonia in Intensive care unit (ICU ) ,ICU physicians have a more reasonable basis for the use of an‐timicrobial agents .Methods The sputum specimens and lavage specimens that were submitted from ICU Jan 2012 to Dec 2013 were retrospectively analyzed ,the bacterial identification and drug susceptibility testing were performed by ,and the date were statistically analyzed .Results The top three species of pathogens isolated from ventilator associated pneumonias pecimens in ‐cluded Acinetobacter baumanii (26.68% ) ,Pseudomonas aeruginosa (18.47% ) ,Klebsiella Lei Bojun (14.08% ) ,while The top three species of pathogens isolated from non ventilator associated pneumonias pecimens included Klebsiella pneumoniae (24.38% ) ,Pseudomonas aeruginosa (21.55% ) ,Escherichia coli (15.9% ) .The detectable rate of Klebsiella pneumoniae andthere was significant difference between the two groups (P < 0 .01) ,while Pseudomonas aeruginosa ,Escherichia coli detec‐tion rate between the two groups had no significant difference .The drug resistance of pathogens isolated from ventilator associ‐ated pneumonias pecimens were common higher than non ventilator associated pneumonias pecimens .Conclusion Composition and drug resistance of pathogens from ventilator‐associated pneumonia and non ventilator‐associated pneumonia are different ,it is necessary for ICU physicians to grasp the distribution and drug resistance of the pathogen ,which has a certain guiding signif‐icance for the use of antimicrobial drugs before results of drug sensitivity test .