摘要
目的探讨ICU呼吸机相关性肺炎(VAP)病原菌的菌谱与防治。方法 2010年1月至2012年10月桂阳县人民医院ICU气管插管并实施机械通气290例患者中发生VAP患者95例,取气管插管并实施机械通气>48 h患者的下呼吸道分泌物,进行细菌定量培养及抗菌药物敏感性测定,并据此采取相应的防控对策。结果 95例ICU VAP患者中各类病原菌混合感染者82例(86.32%),单一感染者13例(13.68%)。95例下呼吸道分泌物培养出病原菌286株,革兰阴性杆菌175株,占61.19%,主要为假单胞菌属、不动杆菌属、克雷伯菌属、肠杆菌属;革兰阳性球菌64株,占22.38%,主要为金黄色葡萄球菌、表皮葡萄球菌、肠球菌属,其中金黄色葡萄球菌大部分为耐甲氧西林金黄色葡萄球菌MRSA(90.5%);真菌感染47株,占16.43%,主要为假丝酵母菌属。主要病原菌药敏试验结果:革兰阴性杆菌对亚胺培南和美洛培南敏感,其次为头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、莫西沙星、阿米卡星、替卡西林/克拉维酸、头孢他啶;对氨苄西林、头孢噻肟、头孢曲松则有较高的耐药性;金黄色葡萄球菌耐药现象严重,对氨苄西林、羧苄西林高度耐药(耐药率为95.7%～99.7%),但对万古霉素、替考拉宁尚敏感。结论 ICU VAP病原菌是以革兰阴性杆菌为主的混合感染,且存在较严重的耐药现象。
Objective To investigate the distribution and drug-resistance of pathogens in patients with ventilator-associated pneumonia in intensive care unit（ICU）.Methods Ninety-five patients suffered from ventilator-associated pneumonia out of 290 patients treated with trachea cannula technique.The secretion of lower respiratory tract of 95 patients receiving tracheostomy and mechanical ventilation for more than 48 hours was cultured with a quantitative method and their antibiotic susceptibility was detected by standard K-B methods in intensive care unit between January 2010 and October 2012.Preventive and treatment strategy was advised.Results There were 82 cases（86.32%） suffered from mixed infections in the 95 patients with ventilator-associated pneumonia.Two hundred and eighty-six strains of pathogens were collected from the secretion of lower respiratory tract of 95 patients with ventilator-associated pneumonia.Out of the 286 strains of pathogens,the mixed infections were 243 strains（84.97%）,Gram-negative bactilli（GNB） 175 strains（61.19%）,the Gram-positive bacteria（GPB） 64 strains（22.38%）,and the fungi 47 strains（16.43%）.Among the GNB,Pseudomonas,Acinetobacter,Klebsiella and Enterobacter were the main pathogens.Among the GPB,Staphylococcus aureus,S.epidermidis and Enterococcus were the main pathogens.Meticillin-resistanet S.aureus（MRSA） accounted for 90.5% in S.aureus.Candida albicans was the main fungus.The antibiotic susceptibility test results showed that GNB was highly susceptible to imipenem and meropenem,cefoperazone/sulbactam,piperacillin/Tazobactam Sodium,Moxifloxacin,amikacin,ticarcillin/clavulanic acid and ceftazidime in proper order.There was a high resistance to ampicillin,cefotaxime and ceftriaxone in GNB.S.aureus had severe drug-resistance（95.7%-99.7%） to ampicillin and carbenicillin,but it was still highly susceptible to vancomycin and teicoplanin.Conclusion GNB are still the most important pathogens in VAP and have multiple drug-resistance.Mixed infections are sev
出处
《临床医学》
CAS
2013年第7期12-14,共3页
Clinical Medicine
关键词
呼吸机相关性肺炎
病原菌
药物敏感性试验
Ventilator-associated pneumonia
Pathogenic bacteria
Antibiotic susceptibility test
