衢州市呼吸机相关性重症肺部感染病原学分布及耐药性探讨(1)
[摘要] 目的 探讨衢州市呼吸机相关性重症肺部感染病原学分布及耐药性。 方法 选取2017年5月～2018年5月入住衢州市医院重症监护病房的呼吸机相关性肺炎患者102例，观察患者病原学分布并分析其耐药性。 结果 102例呼吸机相关性重症肺炎患者中共分离140株病原菌，期中包括7株(5.0%)真菌、35株(25.0%)革兰氏阳性球菌以及98株(70.0%)革兰氏阴性杆菌，在革兰氏阴性杆菌中的铜绿假单胞菌及肺炎克雷伯菌对复方新诺明、环丙沙星、左氧氟沙星以及庆大霉素的耐药率较高，在革兰氏阳性球菌中的金黄色葡萄球菌对舒巴坦、环丙沙星、哌拉西林、左氧氟沙星、庆大霉素、阿米卡星、头孢他啶、头孢曲松、头孢唑啉以及头孢吡肟的耐药率较高。 结论 呼吸机相关性重症肺部感染患者的病原学分布主要为革兰氏阴性菌，且具有多重耐药的特性，应以其耐药性为基础，合理应用药物，确保疗效。
[关键词] 呼吸机相关;重症肺部感染;病原学;耐药性
[中图分类号] R446.5 [文献标识码] B [文章编号] 1673-9701(2020)11-0163-04
Pathogenic distribution and drug resistance of severe pulmonary infection associated with ventilator in Quzhou city
WANG Minyan CHEN Yu HAN Zhiqiang ZHENG Huijin
Department of Respiratory Medicine， Quzhou People's Hospital in Zhejiang Province， Quzhou 324000，China
[Abstract] Objective To investigate the pathogenic distribution and drug resistance of severe pulmonary infection associated with ventilator in Quzhou city. Methods A total of 102 patients with ventilator-associated pneumonia admitted to the intensive care unit of Quzhou city from May 2017 to May 2018 were enrolled. The pathogen distribution was observed and the drug resistance was analyzed. Results A total of 140 pathogens were isolated from 102 patients with severe ventilator-associated pneumonia， including 7(5.0%) fungi， 35(25.0%) gram-positive cocci and 98 (70.0%) gram-negative bacilli. Pseudomonas aeruginosa and klebsiella pneumoniae in gram-negative bacilli were highly resistant to cotrimoxazole， ciprofloxacin， levofloxacin and gentamicin. In gram-positive cocci， staphylococcus aureus had higher resistance rates to sulbactam， ciprofloxacin， piperacillin， levofloxacin， gentamicin， amikacin， ceftazidime， ceftriaxone， cefazolin and cefepime. Conclusion The etiology of ventilator-associated severe pulmonary infection is mainly gram-negative bacteria， and has multi-drug resistance. Clinically， drugs should be rationally used based on its drug resistance to ensure clinical efficacy.
[Key words] Ventilator-association; Severe pulmonary infection; Etiology; Drug resistance
呼吸机相关性肺炎屬于医院获得性肺炎常见类型，同时也是接受机械通气治疗患者最常见的一种并发症，其致死率高出普通人群的4～19倍。呼吸机相关性肺炎指的是肺部感染未出现感染的患者在接受机械通气48 h到拔管后48 h内出现的肺炎，近几年，随医疗水平不断发展，机械通气逐渐成为重症监护病房对患者实施抢救的重要手段之一，而发生呼吸机相关性肺炎的概率较高[1-3]。相关研究指出，重症监护病房内发生呼吸机相关性肺炎的概率约11%～29%，一旦出现，将对患者生命安全产生威胁，因治疗费用、病死率较高已成为国内外的研究热点[4]。呼吸机相关性肺炎具有流行病及地方性特点，危险因素较多，且地区不同，病原菌存在也有所差异。目前准确、迅速的病原学鉴定技术尚未出现，医师通常凭借临床经验用药，如何防治呼吸机相关性肺炎已成为重症监护病房待以解决的问题[5-6]。本文通过观察病原学分布、分析耐药性，为临床药品选择提供参考依据，降低患者死亡率，现报道如下。, http://www.100md.com(王敏焱 陈毓 韩志强 郑慧瑾)
[关键词] 呼吸机相关;重症肺部感染;病原学;耐药性
[中图分类号] R446.5 [文献标识码] B [文章编号] 1673-9701(2020)11-0163-04
Pathogenic distribution and drug resistance of severe pulmonary infection associated with ventilator in Quzhou city
WANG Minyan CHEN Yu HAN Zhiqiang ZHENG Huijin
Department of Respiratory Medicine， Quzhou People's Hospital in Zhejiang Province， Quzhou 324000，China
[Abstract] Objective To investigate the pathogenic distribution and drug resistance of severe pulmonary infection associated with ventilator in Quzhou city. Methods A total of 102 patients with ventilator-associated pneumonia admitted to the intensive care unit of Quzhou city from May 2017 to May 2018 were enrolled. The pathogen distribution was observed and the drug resistance was analyzed. Results A total of 140 pathogens were isolated from 102 patients with severe ventilator-associated pneumonia， including 7(5.0%) fungi， 35(25.0%) gram-positive cocci and 98 (70.0%) gram-negative bacilli. Pseudomonas aeruginosa and klebsiella pneumoniae in gram-negative bacilli were highly resistant to cotrimoxazole， ciprofloxacin， levofloxacin and gentamicin. In gram-positive cocci， staphylococcus aureus had higher resistance rates to sulbactam， ciprofloxacin， piperacillin， levofloxacin， gentamicin， amikacin， ceftazidime， ceftriaxone， cefazolin and cefepime. Conclusion The etiology of ventilator-associated severe pulmonary infection is mainly gram-negative bacteria， and has multi-drug resistance. Clinically， drugs should be rationally used based on its drug resistance to ensure clinical efficacy.
[Key words] Ventilator-association; Severe pulmonary infection; Etiology; Drug resistance
呼吸机相关性肺炎屬于医院获得性肺炎常见类型，同时也是接受机械通气治疗患者最常见的一种并发症，其致死率高出普通人群的4～19倍。呼吸机相关性肺炎指的是肺部感染未出现感染的患者在接受机械通气48 h到拔管后48 h内出现的肺炎，近几年，随医疗水平不断发展，机械通气逐渐成为重症监护病房对患者实施抢救的重要手段之一，而发生呼吸机相关性肺炎的概率较高[1-3]。相关研究指出，重症监护病房内发生呼吸机相关性肺炎的概率约11%～29%，一旦出现，将对患者生命安全产生威胁，因治疗费用、病死率较高已成为国内外的研究热点[4]。呼吸机相关性肺炎具有流行病及地方性特点，危险因素较多，且地区不同，病原菌存在也有所差异。目前准确、迅速的病原学鉴定技术尚未出现，医师通常凭借临床经验用药，如何防治呼吸机相关性肺炎已成为重症监护病房待以解决的问题[5-6]。本文通过观察病原学分布、分析耐药性，为临床药品选择提供参考依据，降低患者死亡率，现报道如下。, http://www.100md.com(王敏焱 陈毓 韩志强 郑慧瑾)