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[目的]分析重症监护病房(ICU)呼吸机相关肺炎(VAP)与医院获得性肺炎(HAP)病原学特征,为临床经验性选择抗菌药物提供依据。[方法]回顾性分析2006年1月～2007年12月入住ICU患者VAP和HAP发生情况,并对临床痰标本分离出的病原菌及其耐药性进行分析。[结果]使用呼吸机的223例患者发生VAP106例次,感染发生率47.5%;未使用呼吸机的538例患者发生HAP124例,感染发生率23.0%。使用呼吸机患者痰标本分离出的173株病原菌占前5位的依次为:铜绿假单胞菌(36.4%),白色念珠菌(13.9%)、鲍曼/溶血不动杆菌(11.6%)、光滑念珠菌(8.7%)、克雷伯菌属(8.1%);未使用呼吸机患者痰标本分离出的181株病原菌占前5位的依次为:铜绿假单胞菌(22.6%),大肠埃希菌(14.9%),金黄色葡萄球菌(12.2%),克雷伯菌属(11.1%),白色念珠菌(9.4%)。[结论]使用呼吸机患者肺部感染发生率高;VAP患者分离出的病原菌非发酵菌比例高于HAP,而HAP患者分离出的病原菌中肠杆菌科细菌和革兰阳性球菌比例高于VAP。应加强ICU感染病原菌及其耐药性监测,采取综合控制措施预防和治疗VAP和HAP。
[Objective] To analyze etiological characteristics of ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP) in intensive care unit (ICU) and provide basis for clinical experience in selecting antimicrobial agents. [Methods] The incidence of VAP and HAP in patients admitted to ICU between January 2006 and December 2007 were retrospectively analyzed. Pathogenic bacteria isolated from clinical sputum samples and their drug resistance were analyzed. [Results] The incidence of infection was 223.5% in 223 patients using ventilator, and 47.5% in 538 patients without ventilator. The incidence of infection was 23.0%. 173 pathogens isolated from sputum samples from patients with ventilator accounted for the top 5, followed by Pseudomonas aeruginosa (36.4%), Candida albicans (13.9%), Acinetobacter baumannii (11.6%), Candida glabrata (8.7%) and Klebsiella spp. (8.1%). The 181 pathogens isolated from the sputum of patients without ventilator accounted for the top 5, followed by Pseudomonas aeruginosa (22.6%), Escherichia coli (14.9%), Staphylococcus aureus (12.2%), Klebsiella (11.1%), Candida albicans (9.4%). [Conclusion] The incidence of pulmonary infection in patients with ventilator is high. The proportion of non-fermentative bacteria isolated from VAP patients is higher than that of HAP, while the proportion of Enterobacteriaceae and Gram-positive cocci isolated from pathogens in HAP patients is higher than that of VAP. ICU should be strengthened to monitor pathogens and their drug resistance monitoring, take comprehensive control measures to prevent and treat VAP and HAP.