摘要
[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 the characteristics of pathogens and bacterial susceptibility in the patients with VAP and HAP in ICU,so as to provide basis for choosing the antibiotics in the clinical experience. [Methods] The retrospectively analyzed the incidence of VAP and HAP on patients in ICU from 2006 to 2007. Pathogens distribution and their drug resistance were also analyzed. [Results] 106 /223（47.5%） VAP cases were diagnosed,while 124 /538（23.0%） HAP cases who did not receive the mechanical ventilation were diagnosed. The top five pathogenic bacteria in ventilated patients were Pseudomonas aeruginosa（36.4%） ,Candida albicans（13.9%） ,Acinetobacter baumannii（11.6%） ,Candida glabrata（8.7%） and Klebsiella（ 8.1% ） ;The top five pathogenic bacteria in non-ventilated patients were Pseudomonas aeruginosa（ 22.6% ） ,Escherichia.coli（14.9%） ,Staphylococcus aureus（12.2%） ,Klebsiella（11.1%） and Candida albicans（9.4%） . [Conclusion] The incidence of pneumonia in ventilated patients was high,and the proportion of non-zymophyte species in ventilated patients was higher than ones in non-ventilated patients,while Enterobacteriaceae and gram-positive cocci species in non ventilated patients was higher than those in non-ventilated patients. Therefore we should strengthen surveillance of the causative microorganisms and their antimicrobial susceptibility. Multiple measures should be taken to prevent and treat VAP and HAP.
出处
《现代预防医学》
CAS
北大核心
2009年第16期3181-3182,3184,共3页
Modern Preventive Medicine
关键词
重症监护病房
呼吸机相关肺炎
医院获得性肺炎
病原学
Intensive care unit
Ventilator-associated pneumonia
Hospital-acquired pneumonia
Microbiology
作者简介
顾克菊（1964-），女，硕士，副研究员，研究方向：医院感染控制与预防
