Analysis on pathogenic microorganism and drug-resistance of ventilator associated pneumonia in ICU
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摘要: 目的 探讨ICU病房中呼吸机相关性肺炎(VAP)的病原学分布及耐药特征。 方法 回顾性研究分析2014年10月—2015年10月收住皖北总院ICU实施有创机械通气且并发VAP患者的病历资料。 结果 纳入研究VAP患者共47例,男性31例,女性16例,年龄14~74岁,气管插管42例次,气管切开26例次。分泌物培养阳性者66例次。取标本培养前应用抗菌药物53例次(80.3%)。并发VAP共66例次,培养病原菌90株,其中G-杆菌58株(64.4%),G+球菌23株(25.6%),真菌9株(10.0%)。前5位病原菌依次为鲍曼不动杆菌16株(17.8%)、铜绿假单胞菌13株(14.4%)、金黄色葡萄球菌11株(12.2%)、肺炎克雷伯菌9株(10.0%)和大肠埃希菌8株(8.9%)。在耐药性方面,鲍曼不动杆菌耐药情况最为严重,对头孢类(100.0%)、氨苄西林/舒巴坦(93.8%)、喹诺酮类(93.8%)抗生素均有较高的耐药性,对头孢哌酮/舒巴坦耐药性最低(43.8%);铜绿假单胞菌对青霉素类(92.3%)耐药性最高,对头孢他啶也达到53.8%的耐药率,对丁胺卡那的耐药性最低,为23.1%;肺炎克雷伯菌对庆大霉素(100.0%)耐药性最高,对亚胺培南的耐药性最低,为11.1%;大肠埃希菌对庆大霉素、复方新诺明(100.0%)耐药性最高,对亚胺培南的耐药性最低,为12.5%;金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)的检出率为54.5%(6/11),未检出对万古霉素、利奈唑胺耐药的菌株。 结论 ICU中VAP感染以G-杆菌为主,且呈多重耐药。Abstract: Objective To investigate the pathogenic distribution and drug resistance characteristics of ventilator associated pneumonia(VAP) in ICU. Methods The medical record datawere retrospectively collected inpatients withinvasive mechanical ventilation who diagnosed VAP in the ICU of our hospital from October,2014 to October,2015. Results A total of 47 patients were enrolled includingmale 31,female 16,age 14 to 74 years old,42 cases with intubation,26 cases with tracheostomy,Sixty-six cases of positive secretion culture,53 cases with application of antimicrobial agents before culture.66 case of VAP were diagnosed. Ninety bacterial strains isolates,which included 58(64. 4%) of gram negative bacilli,23(25. 6%) of gram positive bacteria,and 11(12. 2%) of fungus. The top five pathogenic bacteria were Paumanii(16 strains,17. 8%),Pseudomonas aeruginosa(13 strains,14. 4%),Staphylococcus aureus(11 strains,12. 2%),Klebsiella pneumoniae(9 strains,10%) and Escherichia coli(8 strains,8. 9%). The drug-resistant of Paumanii was the most serious. It has a high drug-resistant rate for Cephalosporins(100. 0%),Ampicillin/sulbactam(93. 8%),Quinolones(93. 8%). The rate of resistance to Cefoperazone/Sulbactam was minimum(48. 3%). The resistance of Pseudomonas aeruginosa to Penicillins(92. 3%) was the highest,to Ceftazidime also reach 53. 8%,to Amikacin(23. 1%) was the lowest. The resistance of Klebsiella pneumoniae to Gentamicin(100. 0%) was the highest,to Imipenem(11. 1%) was the lowest. The resistance of Escherichia coli to Ampicillin(100. 0%),Gentamicin(100. 0%) and Chemitrim(100. 0%) was the highest,to Imipenem(12. 5%) was the lowest. Methicllin-resistant strains in S. aureus(MRSA) accounted for54. 5%(6/11). No staphylococcal strains were found resistant to Vancomycin or linezolid. Conclusion VAP in ICU was mainly caused bygram negative bacilli,and multidrug-resistantare most common.
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