目的 探讨迟发性呼吸机相关性肺炎(VAP)患者的病原菌分布和耐药性.方法 将98例被确诊为迟发性VAP的机械通气患者进行病原学分布和耐药状况监测.结果 纤维支气管镜采样98例共检出致病菌168株,革兰阴性菌占 82.9%,其中非发酵菌占50.2%,肠杆菌科占32.7%;革兰阳性菌占13.5%;真菌占4.6%.前3位致病菌分别为鲍氏不动杆菌(26.9%)、铜绿假单胞菌(13.6%)和肺炎克雷伯菌(10.5%).药敏结果显示前几位革兰阴性菌对常用抗菌药物均有较高耐药性,革兰阳性菌均对万古霉素敏感.结论 迟发性VAP的病原菌以革兰氏阴性菌为主,且呈现多重耐药现象,合适的经验性抗菌药物治疗应根据病原学与耐药性的监测结果.%Objective To probe the pathogenesis and their resistance to antibiotics of late- onset ventilator- associated pneumonia (VAP). M ethods A clinical trial in late- onset VAP episodes of 98 patients receiving mechanical ventilation, The pathogenesis and their resistance to antibiotics were analyed. Results A total of 168 pathogen strains were isolated through fiberbronchoscopy by bacterial culture,The Gram- negative bacteria (GNB)were 82.9％, Non- fermenters were 51.4％ and Enterobacteriaceae were 32.7％ among it ,The Gram- positive bacteria were 13.5％,the fungi 4.6％.The top three pathogen strains with VAP were Acinetobacter baumanii(26.9％),Pseudomonas aeruginosa(13.6％),Kleb siella pneumoniae(10.5％) .GNB were highly resistant to common antimicrobials and demonstrated multi-drug resistance, Drug resistance of the Gram-positive bacteria to vancomycin was Conclusion The major pathogenic bacteria in late- onset VAP is GNB, and there are often demonstrated multi- drug resistance,It is suggested that empiric antimicrobial therapy for patients with late- onset VAP should base on the surveillance of etiology and resistance .
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