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目的分析重症加强治疗病房呼吸机相关性肺炎(VAP)的病原菌分布特点及变迁。方法对中国医科大学附属第一医院重症加强治疗病房(ICU)2003年1月至2006年12月间VAP病人的痰培养病原菌及药敏结果进行回顾性分析。结果4年中ICU中VAP发生率为19.1%。铜绿假单胞菌为最常见菌,洋葱伯克霍尔德菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌4年中均排在前6位。金黄色葡萄球菌在2003-2005年间逐年增加,2006年有所下降;脑膜败血黄杆菌在2005、2006年分离率明显下降;近两年肺炎克雷伯杆菌的分离率增加。2004年铜绿假单胞菌对多种抗生素耐药率高(均在75%以上)。4年中对亚胺培南的耐药率均超过40%。鲍曼不动杆菌对亚胺培南和左氧氟沙星耐药率较低,嗜麦芽窄食单胞菌对复方磺胺甲恶唑、环丙沙星和左氧氟沙星耐药率较低。分离出的金黄色葡萄球菌中,耐甲氧西林金黄色葡萄球菌(MRSA)所占比例高。结论铜绿假单胞菌、洋葱伯克霍尔德菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌等非发酵菌仍为VAP主要致病菌。4年中VAP致病菌的分布特点和耐药性发生了改变。
Objective To analyze the distribution and changes of pathogens in severe pneumonia patients with ventilator-associated pneumonia (VAP). Methods The pathogenic bacteria and drug susceptibility of sputum culture in patients with VAP from January 2003 to December 2006 in the Intensive Care Unit (ICU) of the First Affiliated Hospital of China Medical University were analyzed retrospectively. Results The incidence of VAP in ICU was 19.1% in 4 years. Pseudomonas aeruginosa is the most common bacteria, Burkholderia cepacia, Acinetobacter baumannii, Stenotrophomonas maltophilia were in the top 6 in 4 years. Staphylococcus aureus in 2003-2005 increased year by year, in 2006 decreased; Flavobacterium meningitidis in 2005 and 2006, the separation rate decreased significantly; in recent years Klebsiella pneumoniae isolation rate increased. In 2004, Pseudomonas aeruginosa was highly resistant to various antibiotics (all above 75%). Resistance rates to imipenem over 4 years were over 40%. Acinetobacter baumannii resistance to imipenem and levofloxacin low, Stenotrophomonas maltophilia compound sulfamethoxazole, ciprofloxacin and levofloxacin resistance rate is low. Among the isolated S. aureus, the proportion of methicillin-resistant Staphylococcus aureus (MRSA) is high. Conclusion Non-fermenting bacteria such as Pseudomonas aeruginosa, Burkholderia cepacia, Acinetobacter baumannii and Stenotrophomonas maltophilia are still the main pathogens of VAP. In 4 years, the distribution characteristics and drug resistance of VAP pathogens have changed.