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目的调查呼吸重症监护病房(RICU)慢性阻塞性肺疾病急性发作期(AECOPD)患者发生呼吸机相关性肺炎(VAP)的主要病原菌构成、耐药情况,为临床治疗提供参考。方法经支气管镜防污染毛刷取得2008年1月-2009年12月医院RICU符合VAP的AECOPD患者下呼吸道标本进行细菌分离培养及药敏试验,并进行分析。结果 RICU的AECOPD合并VAP的患者下呼吸道病原菌检出率达84.7%,革兰阴性杆菌是主要的病原菌,占69.4%,其中产ESBLs检出率达58.8%;革兰阳性球菌9株占12.5%,主要是金黄色葡萄球菌,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为66.7%,真菌占18.1%,主要是假丝酵母菌属。结论 RICU的AECOPD患者VAP耐药现象严重,发现泛耐药鲍氏不动杆菌菌株,真菌感染及耐药性增多。
Objective To investigate the composition and drug resistance of major pathogenic bacteria associated with ventilator-associated pneumonia (VAP) in patients with acute episode of chronic obstructive pulmonary disease (AECOPD) in respiratory intensive care unit (RICU), and to provide reference for clinical treatment. Methods From January 2008 to December 2009, the lower respiratory tract specimens of AECOPD patients with RICU who met the VAP were collected for bacterial isolation and drug susceptibility testing by bronchoscope anti-pollution brush. Results The detection rate of lower respiratory tract pathogens in patients with AECOPD complicated with VAP in RICU was 84.7%. Gram-negative bacilli were the major pathogens, accounting for 69.4%, of which ESBLs were detected in 58.8%, 9 strains of Gram-positive cocci (12.5% , Mainly Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA) detection rate was 66.7%, fungi accounted for 18.1%, mainly Candida. Conclusions The VAP resistance of AECOPD patients in RICU is serious. It is found that there is an increase in pan-drug-resistant Acinetobacter baumannii strains, fungal infections and drug resistance.