摘要
目的调查分析近年老年呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者病原菌耐药性,为临床诊疗提供依据。方法以"呼吸机相关性肺炎"、"病原菌"、"耐药性"、"老年患者"为自由词检索中国知网中国期刊全文数据库2009年1月—2014年12月收录的文献,逐一阅读排除重复发表、个案报道等文献。对纳入文献的临床资料、病原菌构成及耐药情况进行分类归纳、统计汇总。结果最终纳入23篇文献,累计患者2595例。共检出病原菌4129株,其中革兰阴性菌3149株(76.27%),革兰阳性菌644株(15.60%),真菌326株(7.90%),非典型病原体10株(0.24%);构成比居前五位的病原菌依次为:铜绿假单胞菌(23.93%)、鲍曼不动杆菌(19.28%)、肺炎克雷伯杆菌(11.36%)、金黄色葡萄球菌(7.82%)和嗜麦芽寡养单胞菌(6.83%)。耐药性分析显示:主要革兰阴性菌对氨苄西林、头孢噻肟钠、头孢曲松钠、环丙沙星等均有明显的耐药性,对多黏菌素B均有良好的敏感性;金黄色葡萄球菌对氨苄西林、阿莫西林、头孢唑林钠、亚胺培南、庆大霉素、利福平、环丙沙星、苯唑西林钠、四环素耐药性非常高,对万古霉素、利奈唑胺、替考拉宁、奎奴普汀/达福普汀均有良好的敏感性。结论随着抗生素的大量使用,VAP病原菌耐药性逐步增高,临床一旦怀疑VAP应立即根据初始经验性抗感染治疗常规选择恰当抗菌谱的抗生素治疗,待病原学检测结果回报后及时调整为敏感抗生素进行目标性治疗。
Objective To provide the basis for clinical diagnosis and treatment, investigation and analysis of drug re- sistance during the period of 2009-2014 in elderly patients with ventilator associated pneumonia pathogenic bacteria. Methods Ventilator associated pneumonia, pathogenic bacteria, drug resistance, elderly patients for free word, searching of the Chi- nese journal of full text database were collected during Jan. 2009 and Dec. 2014, and repeatedly published literature and case report were excluded. The literature of clinical data, pathogens and drug resistance were summarized, and summary statistics was performed. Results A total of 23 articles were included with a total of 2595 patients. A total of 4129 strains of pathogens were isolated, including 3149 strains of gram negative bacteria （76.27%） , 644 strains of gram positive bacteria （15.60%） , 326 strains of fungi （7.90%） , 10 strains （0.24%） of atypical pathogens; the constituent ratio of top five were： pseudo- monas aeruginosa （23.93%） , acinetobacter baumannii （19.28%） , klebsiella pneumoniae （11.36%） , staphylococcus au- reus （7.82%） and stenotrophomonas mahophilia （6.83%）. Drug resistance analysis showed that gram negative bacteria to ampicillin, cefotaxime sodium, ceftriaxone sodium and ciprofloxacin had obvious resistance, but were sensitive to polymyxin B. Staphylococcus aureus against ampicillin, amoxicillin, cefazolin, imipenem, rifampicin, ciprofloxacin, gentamicin, oxacil- lin sodium and tetracycline were sensitive to vancomycin and linezolid, teicoplanin, quinupristin/DA Fop Dean showed good sensitivity. Conclusion With widespread use of antibiotics, drug resistance of pathogenic bacteria of VAP increases gradual- ly. Once VAP is suspected, according to empirical initial anti infection treatment, appropriate antimicrobial spectrum should be selected, when the results of pathogenic detection are obtained, the targeted treatment of antibiotics should be readjusted.
出处
《临床误诊误治》
2015年第7期43-48,共6页
Clinical Misdiagnosis & Mistherapy
关键词
肺炎
呼吸机相关性
老年人
抗菌药
病原菌
耐药性
Pneumonia, ventilator-associated
Elderly
Antibiotics
Pathogen
Drug resistance
