Analysis on the Characteristics and Drug Resistance of Ventilator-associated Pneumonia Pathogens_West China Medical Journal

Authors：

ZHOU Zhongwei , ZOU Jun

Department of Respiration, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;

Corresponding author：

Keywords：

呼吸机相关性肺炎; 病原菌; 耐药; 抗生素

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目的　分析呼吸科重症监护病房（RICU）中呼吸机相关性肺炎（VAP）病原菌的来源、分布特点及耐药情况, 为在RICU中更好地控制VAP提供科学依据。方法　回顾性分析2005年1月－2011年12月期间，医院RICU收治的行机械通气时间＞48 h，住院时间＞7 d的136例VAP患者病原菌分布情况和耐药性等临床资料。结果　RICU中VAP的发生率为42.8%（136/318），病死率为47.8%（65/136）。共分离出病原菌507株，其中G−菌占74.8%（379/507），铜绿假单胞菌居首位，其次为鲍曼不动杆菌和肺炎克雷伯菌；G+球菌占10.3%（52/507），以金黄色葡萄球菌为主；真菌占14.9%（76/507），以白色念珠菌为主。G−杆菌对常用抗菌药物表现出较高的耐药率，其中对青霉素类、头孢菌素类抗菌药物高度耐药，而对碳青霉烯类耐药率相对较低；耐甲氧西林的金黄色葡萄球菌对多种常见抗菌药物高度耐药，但对万古霉素敏感。结论　RICU的VAP病原菌以G−菌为主，耐药情况比较严重，铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌为RICU中的主要致病菌。

Citation： ZHOU Zhongwei,ZOU Jun. Analysis on the Characteristics and Drug Resistance of Ventilator-associated Pneumonia Pathogens. West China Medical Journal, 2012, 27(10): 1471-1473. doi: Copy

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11.	张永利, 范姝文, 万献尧. 重症监护病房中呼吸机相关性肺炎相关因素分析[J]. 中国医师杂志, 2006, 8(3): 380-381.
12.	Sedwick MB, Lance-Smith M, Reeder SJ, et al. Using evidence-based practice to prevent ventilator-associated pneumonia[J]. Crit Care Nurse, 2012, 32(4): 41-51.
13.	Cook D. Ventilator associated pneumonia: perspectives on the burden of illness[J]. Intensive Care Med, 2000, 26(Suppl 1): S31- S37.
14.	Safdar N, Crnich CJ, Maki DG. The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention[J]. Respir Care, 2005, 50(6): 725-739.
15.	周继红，王明明，温勇. 老年呼吸机相关性肺炎患者合并真菌感染的临床特征分析[J]. 中华医院感染学杂志, 2010, 20(5): 663-665.

1. 　Scott SS, Kardos CB. Community-acquired, health care-associated, and ventilator-associated pneumonia: three variations of a serious disease[J]. Crit Care Nurs Clin North Am, 2012, 24(3): 431-441.
2. 　Jaroszewski DE, Webb BJ, Leslie KO. Diagnosis and management of lung infections[J]. Thorac Surg Clin, 2012, 22(3): 301-324.
3. 　Morehead RS, Pinto SJ. Ventilator-associated pneumonia[J]. Arch Intern Med, 2000, 160(13): 1926-1936.
4. 　中华医学会呼吸病学分会. 医院获得性肺炎诊断和治疗指南(草案)[J]. 中华结核和呼吸杂志, 1999, 22(4): 201-202.
5. 　Mariya JN, Sistla S, Kumar DT, et al. Outcome of ventilator-associated pneumonia: impact of antibiotic therapy and other factors[J]. Australas Med J, 2012, 5(2): 135-140.
6. 　孙树梅, 李琼, 王茵茵, 等. 发生呼吸机相关性肺炎的高危因素及病原菌分析[J]. 中华医院感染学杂志, 2006, 16(8): 882-884.
7. 　李志莹，庄鹏，宋冰，等. 重症监护室呼吸机相关性肺炎的危险因素和病原菌分析[J]. 广东医学，2009, 30(2): 255-256.
8. 　陈书文，田玉恒，马原. RICU呼吸机相关性肺炎病原学特点及耐药性分析[J]. 现代预防医学, 2010, 37(20): 3979-3982.
9. 　Bouadma L, Wolff M, Lucet JC. Ventilator-associated pneumonia and its prevention[J]. Curr Opin Infect Dis, 2012, 25(4): 395-404.
10. 　高岩, 李宁, 赵庆华, 等. 重症监护室发生呼吸机相关性肺炎的因素与对策[J]. 中华医院感染学杂志, 2005, 15(10): 1198-1200.
11. 　张永利, 范姝文, 万献尧. 重症监护病房中呼吸机相关性肺炎相关因素分析[J]. 中国医师杂志, 2006, 8(3): 380-381.
12. 　Sedwick MB, Lance-Smith M, Reeder SJ, et al. Using evidence-based practice to prevent ventilator-associated pneumonia[J]. Crit Care Nurse, 2012, 32(4): 41-51.
13. 　Cook D. Ventilator associated pneumonia: perspectives on the burden of illness[J]. Intensive Care Med, 2000, 26(Suppl 1): S31- S37.
14. 　Safdar N, Crnich CJ, Maki DG. The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention[J]. Respir Care, 2005, 50(6): 725-739.
15. 　周继红，王明明，温勇. 老年呼吸机相关性肺炎患者合并真菌感染的临床特征分析[J]. 中华医院感染学杂志, 2010, 20(5): 663-665.

West China Medical Journal

Analysis on the Characteristics and Drug Resistance of Ventilator-associated Pneumonia Pathogens

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