呼吸机相关性肺炎病原菌分布特点及变迁

目的了解近10年来我科监护病房呼吸机相关性肺炎病原菌分布的特点及变迁，为临床抗感染药物的正确应用提供参考资料。方法对1992年10月～2003年1月，VAP患者痰培养病原学及药敏结果进行回顾性分析。结果在近10年来RICU的VAP发生率为35．57％，其中67．35％为≥2种致病菌感染；革兰阴性杆菌中铜绿假单胞菌、不动杆菌属菌为VAP的主要致病菌（65．51％），表皮葡萄球菌为VAP的主要致病革兰阳性球菌，且既往临床认为可选择用来治疗铜绿假单胞菌的抗菌药物敏感率都明显下降，白色念珠菌及其他念珠菌在VAP致病菌中相对减少（13．33％～7．04％），不动杆菌属在VAP致病菌中所占比例显著升高（8．89％～15．49％）。结论铜绿假单胞菌、不动杆菌属为RICU中VAP的主要致病菌，近10年来VAP致病菌的分布特点及耐药性发生了改变。

Etiology of VAP in a RICU from 1992 to 2003

OBJECTIVE To investigate the etiology of ventilator-associated pneumonia(VAP) in our respiratory intensive care unit(RICU) and to explore the antimicrobial resistance of predominant pathogens in last ten years. METHODS From 1992 to 2003,totally 149 cases with VAP were collected for analyzing in our RICU.Standard disk diffusion susceptibility tests were performed on the predominant pathogens. RESULTS During this period,the incidence of VAP in RICU was 35.57%,33 cases were infected by two or more pathogens(67.35% VAP cases).The main pathogens of VAP were Gram negative organisms(65.51%) whose predominant pathogens were Pseudomonas aeruginosa and Acinetobacter.On the other hand,the main Gram positive organisms were Staphylococcus epidermidis.During the recent 10 years,the incidence of Acinetobacter rose up from 8.99% to 15.49% and the rate of Candida decreased from 13.33% to 7.04%. CONCLUSIONS The main pathogens of VAP in our RICU are P.aeruginosa and Acinetobacter,and the changes in pathogens distribution and infection spectrum have been taken place during the past 10 years.