The Analysis of Common Pathogens of Ventilator-associated Pneumonia and Drug Resistance_West China Medical Journal

Authors：

WANG Wei , LI Hongyan , SUN Haiqing , HU Yongxia , YAO Junxiu

Cadre Ward, Chengdu Military General Hospital, Chengdu, Sichuan 610083, P. R. China;

Corresponding author：

Keywords：

呼吸机相关性肺炎; 病原菌; 药敏试验; 抗生素; 预后

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目的　了解呼吸机相关性肺炎（VAP）患者病原菌情况，探讨其细菌耐药性及治疗策略。方法　通过查阅2008年1月－2009年12月呼吸与危重症医学科收治的128例VAP患者的病历资料，分析其肺部感染病原菌分布特点及耐药率。结果　VAP平均发病时间为机械通气后5.8 d，总病死率为35.1%（45/128）。共分离出病原菌262株，其中G?杆菌210株（占80.2%），G+球菌38株（占14.5%），真菌14株（占5.3%）。G?杆菌中占前3位的分别是鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷白杆菌，对青霉素类、头孢菌素类抗菌药物高度耐药，而对亚胺培南等耐药率相对较低；G+球菌主要是金黄色葡萄球菌，其中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，而对万古霉素敏感。结论　VAP的主要病原菌为G?杆菌，常为多重耐药的致病菌，应根据药敏结果选用合理的抗菌药物。

Citation： WANG Wei,LI Hongyan,SUN Haiqing,HU Yongxia,YAO Junxiu. The Analysis of Common Pathogens of Ventilator-associated Pneumonia and Drug Resistance. West China Medical Journal, 2012, 27(4): 521-523. doi: Copy

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2.	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, 2002, 14(3): 160-161.
3.	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.
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8.	Morehead RS, Pinto SJ. Ventilator-associated pneumonia[J]. Arch Intern Med, 2000, 160(13): 1926-1936.
9.	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.
10.	Giamarellou H, Poulakou G. Multidrug-resistant Gram-negative infections: what are the treatment options?[J]. Drugs, 2009, 69(14): 1879-1901.
11.	Ewers C, Grobbel M, Bethe A, et al. Extended-spectrum beta-lactamases-producing gram-negative bacteria in companion animals: action is clearly warranted[J]. Berl Munch Tierarztl Wochenschr, 2011, 124(3-4): 94-101.
12.	Nakayama S, Tribuddharat C, Prombhul S, et al. Molecular analyses of TEM genes and their corresponding penicillinase-producing Neisseria gonorrhoeae isolates in Bangkok, Thailand[J]. Antimicrob Agents Chemother, 2012, 56(2): 916-920.
13.	Bassetti M, Righi E, Fasce R, et al. Efficacy of ertapenem in the treatment of early ventilator-associated pneumonia caused by extended-spectrum beta-lactamase-producing organisms in an intensive care unit[J]. J Antimicrob Chemother, 2007, 60(2): 433-435.
14.	American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia[J]. Am J Respir Crit Care Med, 2005, 171(4): 388-416.
15.	Arroliga AC, Pollard CL, Wilde CD, et al. Reduction in the incidence of ventilator-associated pneumonia (VAP): a multidisciplinary Approach[J/OL]. Respir Care, 2011, DOI: 10.4187/respcare.01392.

1. 　Hunter JD. Ventilator associated pneumonia[J]. Postgrad Med J, 2006, 82(965): 172-178.
2. 　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, 2002, 14(3): 160-161.
3. 　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.
4. 　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.
5. 　毛晓清, 唐春莲, 杨超群. 重症监护病房呼吸机相关性肺炎危险因素的前瞻性研究[J]. 现代预防医学, 2010, 37(13): 2567-2568.
6. 　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.
7. 　Cook D. Ventilator associated pneumonia: perspectives on the burden of illness[J]. Intensive Care Med, 2000, 26(Suppl 1): 31- 37.
8. 　Morehead RS, Pinto SJ. Ventilator-associated pneumonia[J]. Arch Intern Med, 2000, 160(13): 1926-1936.
9. 　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.
10. 　Giamarellou H, Poulakou G. Multidrug-resistant Gram-negative infections: what are the treatment options?[J]. Drugs, 2009, 69(14): 1879-1901.
11. 　Ewers C, Grobbel M, Bethe A, et al. Extended-spectrum beta-lactamases-producing gram-negative bacteria in companion animals: action is clearly warranted[J]. Berl Munch Tierarztl Wochenschr, 2011, 124(3-4): 94-101.
12. 　Nakayama S, Tribuddharat C, Prombhul S, et al. Molecular analyses of TEM genes and their corresponding penicillinase-producing Neisseria gonorrhoeae isolates in Bangkok, Thailand[J]. Antimicrob Agents Chemother, 2012, 56(2): 916-920.
13. 　Bassetti M, Righi E, Fasce R, et al. Efficacy of ertapenem in the treatment of early ventilator-associated pneumonia caused by extended-spectrum beta-lactamase-producing organisms in an intensive care unit[J]. J Antimicrob Chemother, 2007, 60(2): 433-435.
14. 　American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia[J]. Am J Respir Crit Care Med, 2005, 171(4): 388-416.
15. 　Arroliga AC, Pollard CL, Wilde CD, et al. Reduction in the incidence of ventilator-associated pneumonia (VAP): a multidisciplinary Approach[J/OL]. Respir Care, 2011, DOI: 10.4187/respcare.01392.

West China Medical Journal

The Analysis of Common Pathogens of Ventilator-associated Pneumonia and Drug Resistance

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