Objective To analyze the etiological distribution features and resistance conditions of the patho-gens of ventilator-associated pneumonia ( VAP) in COPD patients complicated with respiratory failure, and to provide foundations for clinically reasonable use of antibacterials. Methods A total of 68 eligible patients were selected, bacterial culture and drug sensitive test were done on the secretions of the lower respiratory tracts, and the results were analyzed. Results Of the 68 COPD patients complicated with VAP, 21 cases were attacked by the diseases within 2-4d after mechanical ventilation, and 47 were attacked by the diseases > 4d after mechanical ventilation;45 were improved and free of machine, and 23 died;among them, 7 died of VAP within 4d after mechanical ventilation, and 16 died of VAP more than 4d after mechanical ventilation (P>0. 05). 8 of 39 patients (20. 51%) treated with de-escalation therapy died, and so did 15 of 29 patients (51. 72%) treated with escalation therapy, and the patients treated with de-escalation therapy had a significantly lower fatality rate than those treated with escalation therapy ( P<0. 05). Of the 68 patients, 63 were positive for phlegm bacteriological culture, 100 strains of Gram-negative rod, 25 strains of Gram-positive rod, and 7 strains of fungus were detected. Up to 100% of Staphylococcus aureus was resist-ant to ciprofloxacin, erythromycin, Oxazocilline, and penicillin;and up to 100% of coagulase-negative Staphylococ-cus epidermidis was resistant to Oxazocilline and penicillin. Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacteriaceae, and Pseudomonas maltophilia were most sensitive to Tigecycline, poly-myxin B, Imipenem, and Tigecycline, respectively. Of 7 strains of fungus, 5 (71. 43%) were resistant to flucon-azole, and 4 (57. 14%) were resistant to itraconazole. Conclusion The pathogens of respiratory failure secondary to chronic obstructive lung disease complicated with VAP are highly resistant to common antibacterials, and de-esca-lation therapy can decrease fatality rate and promote rehabilitation.%目的 分析慢性阻塞性肺疾病合并呼吸衰竭患者呼吸机相关性肺炎(VAP)的病原学分布特点及耐药情况,为临床合理应用抗菌药物提供依据.方法 选择符合病例标准的患者68例,其下呼吸道分泌物进行细菌培养和药敏实验,对结果加以分析.结果 68例患者于机械通气后2~4 d发病21例、>4 d发病47例;45例好转并脱机、23例死亡,其中机械通气4 d内发生VAP死亡7例(33.22%)、机械通气超过4 d发生VAP死亡16例(34.04%),差异无统计学意义(P>0.05).采用降阶梯治疗的39例患者死亡8例(20.51%),采用升阶梯治疗的29例患者死亡15例(51.72%),差异有统计学意义(P<0.05).68例患者痰细菌学培养63例阳性,检出革兰阴性杆菌100株、革兰阳性球菌25株、真菌7株.金黄色葡萄球菌对环丙沙星、红霉素、苯唑青霉素、青霉素耐药率高达100%,凝固酶阴性表皮葡萄球菌对苯唑青霉素、青霉素耐药率高达100%.鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯杆菌、肠杆菌科及嗜麦芽窄食单胞菌最敏感抗菌药物分别为替加环素、多粘菌素B、亚胺培南.7株真菌对氟康唑耐药5株(71.43%)、对伊曲康唑耐药4株(57.14%).结论 慢性阻塞性肺疾病呼吸衰竭并VAP患者致病菌对常见抗菌药物耐药率高,病死率高,抗菌药物治疗采用降阶梯法能降低病死率,促进患者康复.
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