CAJ | 학술논문

目的：分析本地区ICU呼吸机相关性肺炎（VAP）的病原菌分布及耐药性特点，更好的指导临床抗菌药物的应用。方法回顾性分析ICU收治的机械通气＞48h的573例患者的资料，对下呼吸道分泌物进行细菌培养、分离和鉴定，药敏试验采用K-B纸片扩散法。结果573例患者中发生VAP 118例，VAP发生率为20.59%。118例患者中共分离出125株病原菌，包括革兰阴性菌97株，占77.6%，革兰阳性菌23株，占18.4%，真菌5株，占4.0%。分布最多的三种细菌为铜绿假单胞菌、鲍曼不动杆菌和金黄色葡萄球菌，分别占22.4%、20.0%和15.2%。常见革兰阴性菌铜绿假单胞菌和鲍曼不动杆菌表现出多重耐药性。结论本地区ICU发生的VAP以革兰阴性菌感染为主，致病菌主要为铜绿假单胞菌和鲍曼不动杆菌，呈现出多重耐药性，临床在经验性治疗过程中，可根据药敏结果进行选择合理的抗菌药物。
목적：분석본지구ICU호흡궤상관성폐염（VAP）적병원균분포급내약성특점，경호적지도림상항균약물적응용。방법회고성분석ICU수치적궤계통기＞48h적573례환자적자료，대하호흡도분비물진행세균배양、분리화감정，약민시험채용K-B지편확산법。결과573례환자중발생VAP 118례，VAP발생솔위20.59%。118례환자중공분리출125주병원균，포괄혁란음성균97주，점77.6%，혁란양성균23주，점18.4%，진균5주，점4.0%。분포최다적삼충세균위동록가단포균、포만불동간균화금황색포도구균，분별점22.4%、20.0%화15.2%。상견혁란음성균동록가단포균화포만불동간균표현출다중내약성。결론본지구ICU발생적VAP이혁란음성균감염위주，치병균주요위동록가단포균화포만불동간균，정현출다중내약성，림상재경험성치료과정중，가근거약민결과진행선택합리적항균약물。
ObjectiveTo analyze the the pathogens and drug resistance of ventilator associated pneumonia (VAP) in ICU,in order to guide the clinical application of antimicrobial agents.Methods573 cases who maintained mechanical ventilation for longer than 48h in ICU were collected in the study.The lower respiratory tract secretions were cultivated,separated and identificated,and the drug sensitive test was done by the K-B disc diffusion method.ReslutsThe VAP were found in 118 cases,and the incidence of VAP was 20.59%.A total of 125 strains of pathogens were isolated,including 97 strains of Gram-negative bacteria,23 strains of Gram-positive bacteria and 5 strains of fungi,accounted for 77.6%,18.4% and 4.0%.The three most common bacteria were Pseudomonas aeruginosa,Acinetobacter baumannii,and Staphylococcus aureus,accounted for 22.4%,20.0% and 15.2%.The Pseudomonas aeruginosa and Acinetobacter baumannii both showed the multiple drug resistance. ConclusionVAP in ICU in our region mainly infected by Gram-negative bacteria,of which Pseudomonas aeruginosa and Acinetobacter baumannii were the most common,presenting the multiple drug resistance.We should choose reasonable antimicrobial agents according to medicine results in empiric treatment process.