| 李艳丽,梁立平,张智荣,游 丽,胡红霞.重症监护病房呼吸机相关肺炎的病原菌分布及耐药性分析[J].,2018,(15):2914-2917 |
| 重症监护病房呼吸机相关肺炎的病原菌分布及耐药性分析 |
| Analysis of Distribution and Drug Resistance of Pathogenic Bacteria of Ventilator-Associated Pneumonia in Intensive Care Unit |
| 投稿时间：2017-12-01 修订日期：2017-12-27 |
| DOI：10.13241/j.cnki.pmb.2018.15.024 |
| 中文关键词: 呼吸机相关肺炎 重症监护病房 耐药性 病原菌 |
| 英文关键词: Ventilator associated pneumonia Intensive care unit Drug resistance Pathogenic bacteria |
| 基金项目:四川省教育厅科研资助课题（17ZA0136） |
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| 中文摘要: |
| 摘要 目的：研究重症监护病房（ICU）呼吸机相关肺炎的病原菌分布及耐药性情况。方法：采集2016年4月-2017年8月于我院ICU住院治疗的58例呼吸机相关肺炎患者痰样本进行病原菌培养，观察病原菌分布情况。同时对主要病原菌进行药敏试验，分析病原菌对头孢他啶、头孢曲松、环丙沙星、奈替米星、妥布霉素、氨曲南、亚胺培南、阿米卡星八种常见抗生素的耐药性情况。结果：58例呼吸机相关肺炎患者共培养204株病原菌，204株病原菌中根据占比分别为革兰氏阴性菌69.61%（142/204）、真菌15.20%（31/204）以及革兰氏阳性菌15.20%（31/204），且革兰氏阴性菌占比均明显高于真菌以及革兰氏阳性菌（P<0.05），其中革兰氏阴性菌中肺炎克雷伯菌占比21.08%（43/204）、铜绿假单胞菌占比18.14%（37/204）、鲍氏不动杆菌占比10.78%（22/204）、产气肠杆菌占比9.31%（19/204）。呼吸机相关肺炎患者病原菌中肺炎克雷伯菌、产气肠杆菌、金黄色葡萄球菌对亚胺培南的耐药性均低于其他七种抗生素，差异有统计学意义（P<0.05），铜绿假单胞菌对奈替米星的耐药性均低于其他七种抗生素，差异有统计学意义（P<0.05），鲍氏不动杆菌耐药性均较高。结论：ICU中呼吸机相关肺炎主要是由革兰氏阴性菌引发，且耐药情况不容乐观，其中革兰氏阴性菌对亚胺培南最为敏感，值得临床重点关注。 |
| 英文摘要: |
| ABSTRACT Objective: To study the distribution and drug resistance of pathogenic bacteria of ventilator-associated pneumonia in intensive care unit (ICU). Methods: Sputum samples were collected from 58 patients with ventilator associated pneumonia who were treated in ICU of our hospital from April 2016 to August 2017 for pathogenic bacteria culture, and the distribution of pathogenic bacteria was observed. At the same time, the main pathogenic bacteria were tested for drug sensitivity, and analyzed the resistance of pathogenic bacteria to eight common antibiotics, including ceftazidime, ceftriaxone, ciprofloxacin, netilmicin and tobramycin, aztreonam, imipenem, amikacin. Results: A total of 204 strains of pathogenic bacteria were isolated from 58 patients with ventilator-associated pneumonia, the proportion in 204 strains of pathogenic bacteria was gram negative bacteria with 69.61% (142/204), fungi with 15.20% (31/204), gram positive bacteria with 15.20% (31/204), respectively, the proportion of gram negative bacteria was significantly higher than that of fungi and gram positive bacteria (P<0.05), among the gram negative bacteria, Klebsiella pneumoniae was accounted for 21.08% (43/204), Pseudomonas aeruginosa was accounted for 18.14% (37/204), Acinetobacter baumannii was accounted for 10.78% (22/204), Enterobac- ter was accounted for 9.31% (19/204). The drug resistance of Klebsiella pneumoniae, Enterobacter cloacae and Staphylococcus aureus to imipenem in the pathogens of patients with ventilator-associated pneumonia were lower than those of the other seven antibiotics, the dif- ference was statistically significant (P<0.05), the drug resistance of Pseudomonas aeruginosa to netilmicin was lower than that of the other seven antibiotics, and the difference was statistically significant (P<0.05), the drug resistance of Acinetobacter baumannii was higher. Conclusion: Ventilator-associated pneumonia in ICU is mainly caused by Gram negative bacteria, and the drug resistance is not optimistic. Among them, gram negative bacteria are most sensitive to imipenem, which is worthy of clinical attention. |
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