CAJ | 학술논문

目的分析重症监护病房(ICU)呼吸机相关性肺炎(VAP)患者下呼吸道分离病原菌的分布及耐药性.方法回顾性分析2008年7月-2011年12月温州市第三人民医院综合性ICU接受有创机械通气治疗的1324例患者的临床资料.根据患者发生VAP的时间将其分为早发性VAP(EOP,于气管插管后4d内发生)和晚发性VAP( LOP,气管插管4d后发生).采用x2检验和t检验比较2组患者下呼吸道分离的病原菌构成和药敏结果等.结果 1324例患者中,552例发生VAP,发生率为41.7％,其中EOP患者74例(5.6％),LOP患者382例(28.9％),二者均发生96例(7.3％).EOP患者分离前6位的病原菌分别为鲍曼不动杆菌(72株,22.6％)、铜绿假单胞菌(45株,14.1％)、肺炎克雷伯菌(32株,10.0％)、白假丝酵母菌(31株,9.7％)、洋葱伯克霍尔德菌(31株,9.7％)和金黄色葡萄球菌(28株,8.8％)；LOP患者分离前6位的病原菌分别为鲍曼不动杆菌(235株,21.2％)、白假丝酵母菌(201株,18.1％)、铜绿假单胞菌(111株,10.0％)、光滑假丝酵母菌(86株,7.8％)、肺炎克雷伯菌(81株,7.3％)和金黄色葡萄球菌(46株,4.2％).其中,EOP患者金黄色葡萄球菌的分离率明显高于LOP患者(x2=10.780,P=0.002),而白假丝酵母菌的分离率明显低于LOP患者(x2=12.907,P=0.000).无论EOP还是LOP患者,革兰阴性杆菌(特别是鲍曼不动杆菌和铜绿假单胞菌)的耐药形势均较为严重；金黄色葡萄球菌中大部分为耐甲氧西林金黄色葡萄球菌(EOP患者:67.9％,19/28；LOP患者:63.0％,29/46)；真菌中的白假丝酵母菌和光滑假丝酵母菌对目前临床常用抗真菌药物的敏感性较好.结论 EOP与LOP患者下呼吸道分离的菌株均以革兰阴性菌为主,菌株耐药形势不容乐观.
목적 분석중증감호병방(ICU)호흡궤상관성폐염(VAP)환자하호흡도분리병원균적분포급내약성.방법 회고성분석2008년7월-2011년12월온주시제삼인민의원종합성ICU접수유창궤계통기치료적1324례환자적림상자료.근거환자발생VAP적시간장기분위조발성VAP(EOP,우기관삽관후4d내발생)화만발성VAP( LOP,기관삽관4d후발생).채용x2검험화t검험비교2조환자하호흡도분리적병원균구성화약민결과등.결과 1324례환자중,552례발생VAP,발생솔위41.7％,기중EOP환자74례(5.6％),LOP환자382례(28.9％),이자균발생96례(7.3％).EOP환자분리전6위적병원균분별위포만불동간균(72주,22.6％)、동록가단포균(45주,14.1％)、폐염극뢰백균(32주,10.0％)、백가사효모균(31주,9.7％)、양총백극곽이덕균(31주,9.7％)화금황색포도구균(28주,8.8％)；LOP환자분리전6위적병원균분별위포만불동간균(235주,21.2％)、백가사효모균(201주,18.1％)、동록가단포균(111주,10.0％)、광활가사효모균(86주,7.8％)、폐염극뢰백균(81주,7.3％)화금황색포도구균(46주,4.2％).기중,EOP환자금황색포도구균적분리솔명현고우LOP환자(x2=10.780,P=0.002),이백가사효모균적분리솔명현저우LOP환자(x2=12.907,P=0.000).무론EOP환시LOP환자,혁란음성간균(특별시포만불동간균화동록가단포균)적내약형세균교위엄중；금황색포도구균중대부분위내갑양서림금황색포도구균(EOP환자:67.9％,19/28；LOP환자:63.0％,29/46)；진균중적백가사효모균화광활가사효모균대목전림상상용항진균약물적민감성교호.결론 EOP여LOP환자하호흡도분리적균주균이혁란음성균위주,균주내약형세불용악관.
Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from lower respiratory tracts of early onset and late-onset ventilator-associated pneumonia (VAP)patients in intensive care unit. Methods A retrospective analysis was performed on data collected from1324 patients admitted to the ICU in the Third People' s Hospital in Wenzhou from July 2008 to December 2011 who received invasive mechanical ventilation.Patients were divided into early-onset pneumonia group (EOP,≤ 4 d mechanical ventilation ) and late-onset pneumonia group (LOP, ＞ 4 d mechanical ventilation).x2 or t test was performed to compare the pathogen distribution and antimicrobial resistance between two groups.Results In 1324 patients,552 (41.7％) suffered from VAP,including 74 ( 5.6％ )patients with EOP,382 (28.9％) patients with LOP,and 96 (7.3％) patients with both EOP and LOP.The top 6 pathogens in EOP group were Acinetobacter baumannii ( 72,22.6％ ),Pseudomonas aeruginosa (45,14.1％ ),Klebsiella pneumoniae (32,10.0％ ),Canidia albicans ( 31,9.7％ ),Burkholderia cepacia ( 31,9.7％ ) and Staphyloccocus aureus ( 28,8.8％ ) ; and in LOP group were Acinetobacter baumannii (235,21.2％ ),Canidia albicans (201,18.1％ ),Pseudomonas aeruginosa ( 111,10.0％ ),Candida glabrata ( 86,7.8％ ),Klebsiella pneumoniae ( 81,7.3％ ) and Staphyloccocus aureus ( 46,4.2％ ).Staphylococcus aureus infection in EOP group was more common than that in the LOP group (x2 =10.780,P =0.002),but the separation rate of Candida albicans in EOP group was significantly lower than that in the LOP group (x2 =12.907,P =0.000).Gram-negative bacteria isolated from EOP or LOP group were both highly resistant to most commonly used antibacterial agents,especially for Acinetobacter baumannii and Pseudomonas aeruginosa strains. Most Staphyloccocus aureus strains were methicillin-resistant strains (EOP:67.9％,19/28; LOP:63.0％,29/46).Canidia albicans and Candida glabrata were sensitive to most antifungal agents.Conclusion For both EOP and LOP groups,the majority of pathogens isolated from lower respiratory tract are Gram-negative bacteria,and drug resistance is serious.