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目的 探讨铜绿假单胞菌 (PA)致呼吸机相关性肺炎 (VAP)的危险因素及其耐药性的分布情况。方法 分析急诊ICU内 89例铜绿假单胞菌呼吸机相关性肺炎患者的临床资料 ,用法国ATB微生物自动检测系统对痰或支气管肺泡灌洗 (BAL)液进行细菌学鉴定 ,并用美国国家临床实验室标准委员会 (NCCLS)的最低抑菌浓度 (MIC)法进行药物敏感试验。结果 检出PA的平均时间在机械通气后 6d ,发生PA VAP的危险因素为 :人工气道的建立、呼吸机管路的污染、广谱抗生素的大量应用。在常用的 13种抗菌药物中 ,致呼吸机相关性肺炎的绿假单胞菌仅对亚胺培南、阿米卡星、头孢他啶和妥布霉素较敏感 ,耐药率低于4 0 %。结论 铜绿假单胞菌耐药率高、耐药谱广 ,其耐药的机理主要与生物被膜 (BF)的形成有关。
Objective To investigate the risk factors and the distribution of drug resistance in ventilator-associated pneumonia (PAP) caused by Pseudomonas aeruginosa (PA). Methods The clinical data of 89 patients with Pseudomonas aeruginosa ventilator-associated pneumonia in emergency ICU were analyzed. Bacteriological identification of sputum or bronchoalveolar lavage (BAL) fluid was carried out by ATB automatic detection system in France. Drug susceptibility testing was performed using the Minimum Inhibitory Concentration (MIC) method of the National Standards Committee (NCCLS). Results The mean time to detect PA was 6 days after mechanical ventilation. The risk factors of PA VAP were: the establishment of artificial airway, the pollution of ventilator pipeline and the extensive application of broad-spectrum antibiotics. Of the 13 commonly used antimicrobials, P. aeruginosa that causes ventilator-associated pneumonia is more sensitive to imipenem, amikacin, ceftazidime and tobramycin only and has a resistance rate of less than 40% . Conclusions Pseudomonas aeruginosa has high drug resistance rate and broad spectrum of drug resistance. The mechanism of drug resistance is mainly related to the formation of biofilm (BF).