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目的探讨ICU病房中呼吸机相关性肺炎(VAP)的病原学分布及耐药特征。方法回顾性研究分析2014年10月—2015年10月收住皖北总院ICU实施有创机械通气且并发VAP患者的病历资料。结果纳入研究VAP患者共47例,男性31例,女性16例,年龄14~74岁,气管插管42例次,气管切开26例次。分泌物培养阳性者66例次。取标本培养前应用抗菌药物53例次(80.3%)。并发VAP共66例次,培养病原菌90株,其中G-杆菌58株(64.4%),G+球菌23株(25.6%),真菌9株(10.0%)。前5位病原菌依次为鲍曼不动杆菌16株(17.8%)、铜绿假单胞菌13株(14.4%)、金黄色葡萄球菌11株(12.2%)、肺炎克雷伯菌9株(10.0%)和大肠埃希菌8株(8.9%)。在耐药性方面,鲍曼不动杆菌耐药情况最为严重,对头孢类(100.0%)、氨苄西林/舒巴坦(93.8%)、喹诺酮类(93.8%)抗生素均有较高的耐药性,对头孢哌酮/舒巴坦耐药性最低(43.8%);铜绿假单胞菌对青霉素类(92.3%)耐药性最高,对头孢他啶也达到53.8%的耐药率,对丁胺卡那的耐药性最低,为23.1%;肺炎克雷伯菌对庆大霉素(100.0%)耐药性最高,对亚胺培南的耐药性最低,为11.1%;大肠埃希菌对庆大霉素、复方新诺明(100.0%)耐药性最高,对亚胺培南的耐药性最低,为12.5%;金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)的检出率为54.5%(6/11),未检出对万古霉素、利奈唑胺耐药的菌株。结论 ICU中VAP感染以G-杆菌为主,且呈多重耐药。
Objective To investigate the etiological distribution and drug resistance of ventilator-associated pneumonia (VAP) in ICU wards. Methods Retrospective analysis and analysis of medical records from October 2014 to October 2015 in the ICU of Wanbei General Hospital for patients with invasive VAP complicated with VAP. Results A total of 47 patients with VAP were included in the study. There were 31 males and 16 females, aged 14-74 years. Tracheal intubation was performed in 42 cases and tracheotomy in 26 cases. Secretion culture positive 66 cases. Antibiotics were pretreated with 53 specimens (80.3%) before specimen culture. A total of 66 cases were complicated with VAP, and 90 strains of pathogenic bacteria were cultured. Among them, 58 strains (64.4%) of G-bacteria, 23 strains (25.6%) of Gococcus and 9 strains (10.0%) of fungi. The top 5 pathogenic bacteria were Acinetobacter baumannii (17.8%), Pseudomonas aeruginosa (14.4%), Staphylococcus aureus (12.2%), Klebsiella pneumoniae (9) %) And Escherichia coli 8 (8.9%). In terms of drug resistance, Acinetobacter baumannii was the most serious drug-resistant strain with high resistance to cephalosporins (100.0%), ampicillin / sulbactam (93.8%) and quinolones (93.8%) Resistance to cefoperazone / sulbactam was the lowest (43.8%); Pseudomonas aeruginosa was the most resistant to penicillins (92.3%) and resistant to ceftazidime 53.8% The lowest resistance of Canna was 23.1%. Klebsiella pneumoniae showed the highest resistance to gentamicin (100.0%) and the lowest resistance to imipenem (11.1%). Escherichia coli The drug resistance to gentamycin and cotrimoxazole (100.0%) was the highest, and the resistance to imipenem was the lowest (12.5%). Staphylococcus aureus methicillin-resistant Staphylococcus aureus (MRSA) The detection rate was 54.5% (6/11). No strains resistant to vancomycin and linezolid were detected. Conclusion The infection of VAP in ICU is mainly G-bacilli, and it is multi-drug resistant.