摘要
目的了解重症监护病房(ICU)中呼吸机相关性肺炎(VAP)病原菌的分布、耐药性特点以及发病危险因素,为预防VAP和抗菌药物的应用提供指导。方法对2008年6月-2009年5月确诊VAP患者,下呼吸道痰标本分离到的病原菌进行鉴定和药敏学分析,并以单因素分析评价VAP发生的危险因素。结果VAP患者所有痰标本培养后共分离出82株病原菌,其中主要为革兰阴性杆菌,占69.51%;其他病原菌包括革兰阳性球菌(25.61%)和真菌(4.88%);最常见的病原菌依次为乙酸钙鲍氏复合不动杆菌、金黄色葡萄球菌、铜绿假单胞菌等;革兰阴性杆菌尤其是乙酸钙鲍氏复合不动杆菌对各种常用抗菌药物耐药严重,革兰阳性球菌中金黄色葡萄球菌中MRSA占77.8%,但对万古霉素均敏感;机械通气时间>5 d,年龄>65岁,曾使用抑酸剂以及白蛋白<30 g/L均为VAP发生的危险因素。结论革兰阴性杆菌是ICU导致VAP的主要病原菌,且对多种抗菌药物耐药,MRSA为VAP重要的病原菌,应根据病原学及药敏结果合理用药,对VAP发生的危险因素应实行重点监控并积极避免。
OBJECTIVE To investigate pathogens,drug resistance and the risk factors of ventilator-associated pneumonia（VAP） in our intensive care unit（ICU）.METHODS Spetum samples collected from the low respiratory trachea of the VAP patients from July 2008 to May 2009 in ICU received bacterial culture and antibiotics sensitive test.The risk factors related to VAP were identified and evaluated with Chi-square test.RESULTS 82 strains of pathogens had been isolated by culture and most of which were Gram negative bacilli（69.51%）.The other pathogens included Gram positive cocci（25.61%） and fungi（4.88%）.The most common pathogens were Acinetobacter calcoaceticus-baumannii,Staphylococcus aureus and Pseudomonas aeruginosa.Most of the Gram negative bacilli were highly resistant to many kind of antibiotics,especially Acinetobacter calcoaceticus-baumannii.77.8% of S.aureus were Meticillin-resistant S.aureus（MRSA）,and all sensitive to Vancomycin.The duration of mechanical ventilation≥5 days,age≥65 years,gastric acid secretion inhibitor（GASI） therapy and albumen 30g/L were the risk factors for VAP.CONCLUSIONS Gram negative bacilli are the main pathogen of VAP,and they are highly resistant to the most antibiotics agents,and MRSA is the next important pathogen of VAP.The choice of antibiotics should be according to the pathogens and antibiotics sensitivity test.The risk factors of VAP can be key-monitored and actively avoided.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2009年第24期3338-3340,共3页
Chinese Journal of Nosocomiology
基金
浙江省中医药科技计划(2005CA040)
关键词
重症监护病房
呼吸机相关性肺炎
病原菌
耐药性
危险因素
Intensive care unit
Ventilator-associated pneumonia
Pathogens
Antibiotics resistance
Risk factors
