摘要
目的探讨医院呼吸机相关性肺炎(VAP)老年患者感染病原菌分布及耐药情况。方法收集2009年1月至2014年1月我院收治的598例进行机械通气老年患者的临床资料进行回顾性调查,从资料中筛选出VAP老年患者并对VAP老年患者下呼吸道分泌物培养及病原菌耐药结果进行统计分析。结果 598例进行机械通气患者中共有221例患者并发有VAP(发生率为36.9%),下呼吸道痰液共分离出251株致病菌,其中有30例发生2种病原菌感染;其中革兰阴性菌分离率最高,占71.3%,其次为革兰阳性菌(占17.9%)、真菌(占10.8%);革兰阴性菌中前3位病原菌依次为鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌,分别占24.3%、17.9%、9.2%;鲍曼不动杆菌和铜绿假单胞菌泛耐药菌株的检出率分别为21.8%和22.2%,产ESBLs细菌检出率为53.6%。革兰阳性菌中,以金黄色葡萄球菌和表皮葡萄球菌为主,耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林表皮葡萄球菌(MRSE)检出率分别为66.7%和64.7%。结论 VAP的病原菌以革兰阴性菌为主,相关菌株耐药性逐渐增高,及时监测相关病原菌耐药性对指导临床合理用药至关重要。
] Objective To investigate the distribution and drug resistance of pathogens of ventilator-associated pneumonia （VAP） in elderly patients. Methods 598 mechanical ventilation patients who enrolled in the hospital from January 2009 to January 2014 were retrospectively reviewed and the results of sputum culture and antibiotic resistance of pathogens from VAP elderly patients were analyzed. Results There were 221 elderly patients suffered from VAP （incidence rate 36. 9% ）of 598 elderly patients treated with mechanical ventilation. 251 strains of pathogens were isolated in low- er respiratory tract sputum specimens. Among them, the isolation rate of the gram-negative bacteria was the highest （71.3%）, followed by the gram-positive bacteria （17. 9%） and the fungi （10. 8%）. The Acinetobacter banmannii, Pseudomonas aeruginosa, Escherichia coli were the top three species of pathogens, sharing of 24. 3%, 17. 9%, 9. 2%, respectively. The isolation rate of the pan-resistant strains of Acinetobacter baumannii and Pseudomonas aeruginosa was 21.8% and 22. 2%, respectively; the isolation rate of the ESBLs-producing bacteria was 53.6 %. Among the Gram-positive bacteria, the Staphylococcus aureus and Staphylococcus epidermidis were the most common bacteria and the isolation rate of methicillin-resistant Staphylococcus aureus （MRSA） and methicillin-resistant Staphylococcus epidermidis （MRSE） were 66. 7% and 64. 7 %, respectively. Conclusions The gram-negative bacteria remain dominant in the pathogens causing VAP, and related strains are highly drug resistant. It is crucial for timely monitoring of drug resistance of the pathogens to guide drug useing rationaly.
出处
《实用老年医学》
CAS
2014年第8期678-680,共3页
Practical Geriatrics
基金
国家临床重点专科(2012ZX10004-207)
关键词
呼吸机相关性肺炎
病原菌
耐药
ventilator-associated pneumonia
pathogens
antimicrobial resistance
