国际医药卫生导报
國際醫藥衛生導報
국제의약위생도보
INTERNATIONAL MEDICINE & HEALTH GUIDANCE NEWS
2012年
11期
1607-1611
,共5页
郑伟浩%张丽珊%伍国达%赵英萍
鄭偉浩%張麗珊%伍國達%趙英萍
정위호%장려산%오국체%조영평
呼吸机相关性肺炎%重症监护室%病原菌%抗药性%抗菌药物
呼吸機相關性肺炎%重癥鑑護室%病原菌%抗藥性%抗菌藥物
호흡궤상관성폐염%중증감호실%병원균%항약성%항균약물
Ventilator-associated pneumonia%Intensive care unit%Pathogen%Antibacterials%Drug resistance
目的 了解重症监护室( ICU)呼吸机相关性肺炎(VAP)的病原菌分布及其耐药情况.方法 对我院ICU 2008年1月至2010年12月诊断为VAP的251例患者病原学资料进行回顾性分析.结果 检出病原菌737株,其中革兰阴性菌(G-)346株(46.9％),主要为铜绿假单胞菌(113株)、肺炎克雷伯杆菌(58株)和鲍曼不动杆菌(57株)；革兰阳性菌( G+) 213株(28.9％),主要为金黄色葡萄球菌(91株,MRSA 63株)、表皮葡萄球菌(45株)和溶血葡萄球菌(42株)；真菌178株(24.2％)；混合感染183例(72.9％).葡萄球菌对万古霉素和利奈唑胺的敏感率均为100％;肺炎克雷伯菌和大肠埃希菌对碳青霉烯类耐药率低于5％;铜绿假单胞菌对多粘菌素B耐药率(1.2％)最低,其次为阿米卡星(26.9％)、哌拉西林/他唑巴坦(33.2％),对碳青霉烯类耐药率超过60％；鲍曼氏不动杆菌对米诺环素、亚胺培南、氨苄西林/舒巴坦的耐药率不超过20％；白色念珠菌的耐药率低.结论 VAP的主要病原菌为革兰阴性菌,混合感染率和细菌耐药率都很高.
目的 瞭解重癥鑑護室( ICU)呼吸機相關性肺炎(VAP)的病原菌分佈及其耐藥情況.方法 對我院ICU 2008年1月至2010年12月診斷為VAP的251例患者病原學資料進行迴顧性分析.結果 檢齣病原菌737株,其中革蘭陰性菌(G-)346株(46.9％),主要為銅綠假單胞菌(113株)、肺炎剋雷伯桿菌(58株)和鮑曼不動桿菌(57株)；革蘭暘性菌( G+) 213株(28.9％),主要為金黃色葡萄毬菌(91株,MRSA 63株)、錶皮葡萄毬菌(45株)和溶血葡萄毬菌(42株)；真菌178株(24.2％)；混閤感染183例(72.9％).葡萄毬菌對萬古黴素和利奈唑胺的敏感率均為100％;肺炎剋雷伯菌和大腸埃希菌對碳青黴烯類耐藥率低于5％;銅綠假單胞菌對多粘菌素B耐藥率(1.2％)最低,其次為阿米卡星(26.9％)、哌拉西林/他唑巴坦(33.2％),對碳青黴烯類耐藥率超過60％；鮑曼氏不動桿菌對米諾環素、亞胺培南、氨芐西林/舒巴坦的耐藥率不超過20％；白色唸珠菌的耐藥率低.結論 VAP的主要病原菌為革蘭陰性菌,混閤感染率和細菌耐藥率都很高.
목적 료해중증감호실( ICU)호흡궤상관성폐염(VAP)적병원균분포급기내약정황.방법 대아원ICU 2008년1월지2010년12월진단위VAP적251례환자병원학자료진행회고성분석.결과 검출병원균737주,기중혁란음성균(G-)346주(46.9％),주요위동록가단포균(113주)、폐염극뢰백간균(58주)화포만불동간균(57주)；혁란양성균( G+) 213주(28.9％),주요위금황색포도구균(91주,MRSA 63주)、표피포도구균(45주)화용혈포도구균(42주)；진균178주(24.2％)；혼합감염183례(72.9％).포도구균대만고매소화리내서알적민감솔균위100％;폐염극뢰백균화대장애희균대탄청매희류내약솔저우5％;동록가단포균대다점균소B내약솔(1.2％)최저,기차위아미잡성(26.9％)、고랍서림/타서파탄(33.2％),대탄청매희류내약솔초과60％；포만씨불동간균대미낙배소、아알배남、안변서림/서파탄적내약솔불초과20％；백색념주균적내약솔저.결론 VAP적주요병원균위혁란음성균,혼합감염솔화세균내약솔도흔고.
Objective To investigate the distribution and drug resistance of the pathogens responsible for ventilator-associated pneumonia ( VAP ) in intensive care unit.Methods The etiological data on 251 patients who had been diagnosed as VAP from January 2008 to December 2010 in the ICU were analyzed retrospectively.Results A total of 737 pathogens were isolated,346 ( 46.9％ ) of which were gram-negative,mainly Pseudomonas aeruginosa ( 113strains ),Klehacteria pneumoniae ( 58 strains ),and Acinetohacter baumannii ( 57 strains ); 213 ( 28.9％ ) were gram-positive,mostly Staphylococcus aureus( 91 strains,MRSA 63 strains ),Staphylococcus epidermidis( 45 strains ),and.Staphylococcus haemolyticus ( 42 strains ); 178 ( 24.2％ ) strains were fungi.Mixed infection developed in 183 ( 72.9％ ) patients.The sensitive rate of Staphylococcus to vancomycin and linezolid was 100％ ; the resistance rate of Klebsiella pneumoniae or Eschenichia colito carbapenem was less than 5％ the resistance rate of Pseudomonas aeruginosa to polymyxin B was the lowest ( 1.2％ ),followed by amikacin ( 26.9％ ),piperacillin/tazobactam ( 33.2％ ),and carbapenem ( more than 60％ ) the resistance rate ofAcinetobacter baumannii to minocycline,imipenem,and ampicillin/sulbactam were less than 20％.The resistance rates was lower in Candida albicans.Conclusions The main pathogen responsible for VAP is gram-negative bacteria.Rates of mixed infection and drug resistance are very high.
