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张长春 贾晓君 郭金玲 摘要
解放军第306医院ICU 北京 100101 目的：分析医院综合ICU 呼吸机相关性肺炎(VAP)病原菌的分布特点及其耐
药性,为V A P治疗提供合理用药参考。方法：回顾性分析210例V A P患者的下呼吸道
分泌物细菌培养及药敏结果。结果：210例V A P患者下呼吸道分泌物培养出病原菌
394株,革兰阴性杆菌占78.4%,革兰阳性球菌占12.6% ,真菌感染9.0%;各类病原菌
混合感染者占83.8%;常见病原菌为鲍曼不动杆菌20.3%，铜绿假单胞菌18.8%，肺
炎克雷伯菌16.2%，金黄色葡萄菌8.1%，耐甲氧西林金黄色葡萄球菌（MRSA）检出
率87.5%，白色念珠菌7.6%。鲍曼不动杆菌仅对头孢哌酮/舒巴坦敏感,铜绿假单胞
菌仅对头孢哌酮/舒巴坦和碳青酶烯类药物敏感,肺炎克雷伯菌和大肠埃希菌对碳
青酶烯类药物敏感,金黄色葡萄球菌耐药现象严重,对万古霉素和替考拉宁敏感,白
色念珠菌对氟康唑、伊曲康唑、伏立康唑敏感。结论：VAP的主要病原菌以革兰阴
性杆菌为主,耐药现象严重,多数为混合感染,治疗困难。进行细菌培养和药物敏感
性试验,对合理选用抗菌药物治疗VAP具有重要意义。
关键词：呼吸机相关性肺炎; 病原菌; 药物敏感性; 耐药性
责任作者及联系方式：张长春，E-mail: zhcca23456@sina.com
I C U呼吸机相关性肺炎病原菌的构成及耐药
性分析
Distribution and Drug-resistance of Pathogens in Patients with Ventilator-
associated Pneumonia in ICU
Chang-chun Zhang, Xiao-jun Jia, Jin-ling Guo
Department of ICU, the 306th Hospital of Chinese People’s Liberation Army, Beijing 100101, China
Abstract
Objective: To determine the distribution and drug resistance characteristic of pathogens in patients with ventilator-associated pneumonia (VAP) and
direct clinical doctors to select antibiotics correctly.
Methods: The secretion of lower respiratory tract of 210 patients received tracheostomy and mechanical ventilation for more than 48 hours was
cultured with a quantitative method and their antibiotic susceptibility was detected.
Results: Gram-negative bacilli (GNB) were the main pathogens in VAP. Among 394 strains of pathogens collected, the GNB occupied 78.4%, the
Gram-positive bacteria (GPB) were 12.6 %, and the fungi were 9.0%. The mixed infections attained to 83.8 %. Pseudomonas aeruginosa was susceptible to
ceftazidime and carbopenems .Mostly Klebsiella were susceptible to carbopenems. Staphylococcus aureus was still highly susceptible to vancomycin.
Conclusion: GNB are still the most important pathogens in VAP and have multiple drug-resistances. Mixed infections are severe, bacterial culture
and antibiotic susceptibility tests are very important to select antibiotics correctly for treatment of VAP.
Key Words: Ventilator-associated pneumonia (VAP); Pathogens; Drug susceptibility; Drug-resistance
Corresponding Author: Chang-chun Zhang, E-mail: zhcca23456@sina.com
呼吸机相关性肺炎(V A P)是指患者机械通气48-72小时发 一、资料与方法
生的肺部感染[1]。一旦出现V A P则容易造成脱机困难,延长患 1.临床资料
者机械通气、住院时间,增加医疗费用，增加死亡率。为有效
治疗V A P,明确感染菌群的流行分布及耐药特点,现对我科210 我科确诊的V A P患者共210例,男性122例,女性88例,年龄
例I C U内V A P患者的病原菌构成、耐药监测结果进行回顾性分 26～85岁,平均(72±16)岁。主要基础疾病为:慢性阻塞性肺
析,为临床治疗VAP,合理使用抗菌素提供依据。 疾病并呼吸衰竭64例，重症肺炎46例,急性呼吸窘迫综合征
(ARDS)32例,脑血管意外30例,感染性休克28例,心肺复苏术后
Laboratory and Clinical Investigation 62 FAM 2013 Jan/Feb Vol.20 Issue 1
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