CAJ | 학술논문

目的：分析重症医学科呼吸机相关肺炎（ventilator-associated pneumonia，VAP）的病原学特点及细菌对抗生素的敏感性，为临床选择抗生素提供依据。方法：回顾分析2012年1月—2013年12月苏州大学附属第三医院重症医学科收治的32例 VAP 的细菌感染情况及细菌对抗生素的敏感性。结果：32例 VAP 中检出110株菌，其中革兰阴性杆菌48株（43．6％），以鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌为主；革兰阳性球菌43株（39．1％），以肠球菌、金黄色葡萄球菌、表皮葡萄球菌和溶血葡萄球菌为主；真菌19株（17．3％），以白色念珠菌为主。药敏试验结果显示，鲍曼不动杆菌、肺炎克雷伯菌和大肠埃希菌对碳青霉烯类的敏感率较其他抗生素高，未发现对万古霉素和利奈唑胺耐药的肠球菌和葡萄球菌。结论：重症医学科 VAP 患者感染革兰阴性杆菌比例稍高于革兰阳性球菌。临床上应根据细菌病原学及对抗生素的敏感性，合理选择抗生素来控制重症医学科内感染的发生，减少耐药菌株的出现。
목적：분석중증의학과호흡궤상관폐염（ventilator-associated pneumonia，VAP）적병원학특점급세균대항생소적민감성，위림상선택항생소제공의거。방법：회고분석2012년1월—2013년12월소주대학부속제삼의원중증의학과수치적32례 VAP 적세균감염정황급세균대항생소적민감성。결과：32례 VAP 중검출110주균，기중혁란음성간균48주（43．6％），이포만불동간균、폐염극뢰백균、동록가단포균화대장애희균위주；혁란양성구균43주（39．1％），이장구균、금황색포도구균、표피포도구균화용혈포도구균위주；진균19주（17．3％），이백색념주균위주。약민시험결과현시，포만불동간균、폐염극뢰백균화대장애희균대탄청매희류적민감솔교기타항생소고，미발현대만고매소화리내서알내약적장구균화포도구균。결론：중증의학과 VAP 환자감염혁란음성간균비례초고우혁란양성구균。림상상응근거세균병원학급대항생소적민감성，합리선택항생소래공제중증의학과내감염적발생，감소내약균주적출현。
Objective:To investigate the etiologic characteristics,as well as the sensitivity of bacteria to antibiotics,in ventila-tor-associated pneumonia(VAP)in Department of Critical Care Medicine,so as to provide evidence for empirical antimicrobial treatment.Methods:The bacterial infection,as well as the sensitivity of bacteria to antibiotics,in 32 VAP cases in Department of Critical Care Medicine in The Third Hospital,Soochow University from Jan 2012 to Dec 2013 were retrospectively analyzed. Results:A total of 110 strains of bacteria were found from 32 VAP cases,including 48 gram negative bacilli(43.6%),43 gram positive cocci(39.1%)and 19 fungi(17.3%).Gram negative bacilli mainly consisted of Baumanii and Klebsiella,Pseudomonas aeruginosa and Escherichia coli.Gram positive cocci mainly consisted of Enterococci and Staphylococcus aureus,Staphylococcus epidermidis and Staphylococcus haemolyticus.Fungi mainly consisted of Candida albicans.Drug sensitive test results showed that Baumanii,Klebsiella and Escherichia coli were more sensitive to carbapenems than to other antibiotics and no Enterococci and Staphylococci was found resistant to vancomycin and linezolid.Conclusions:More VAP patients in Department of Critical Care Medicine were infected by gram negative bacilli.In clinical,empirical antimicrobial treatment should be selected reasonably according to the bacterial etiology and the sensitivity of bacteria to antibiotics,so as to control the infection in Department of Critical Care Medicine and reduce the emergence of drug resistant bacteria.