呼吸机相关性肺炎的病原体及其耐药模式——治疗面临的威胁
Aetiological agents of ventilator-associated pneumonia and its resistance pattern - a threat for treatment.
作者信息
Charles Mv Pravin, Easow Joshy M, Joseph Noyal M, Ravishankar M, Kumar Shailesh, Sivaraman Umadevi
机构信息
Departments of Microbiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India.
出版信息
Australas Med J. 2013 Sep 30;6(9):430-4. doi: 10.4066/AMJ.2013.1710. eCollection 2013.
BACKGROUND
Ventilator-associated pneumonia (VAP) is a common type of nosocomial pneumonia encountered in intensive care units. There are several aetiological agents which make treatment challenging. Improper antibiotic treatment of ventilated patients may lead to the emergence of multidrug resistant (MDR) pathogens.
METHOD
A prospective study was performed over a period of 20 months. Our study had two arms: the first, 'Incidence and risk factors of VAP in a tertiary care hospital' was the subject of an earlier publication; we therefore present the second investigative arm in this work. The aetiological agents of patients on mechanical ventilation (MV) were identified by standard bacteriological method. The susceptibility pattern was evaluated by Kirby-Bauer disc diffusion method. Extended spectrum beta lactamase (ESBL) testing was performed by combination disc method, and metallo-beta lactamase (MBL) testing was performed by EDTA disk synergy test (EDS).
RESULTS
Late-onset VAP was associated with Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli, while early-onset VAP was commonly caused by members of Enterobacteriaceae, Candida albicans and Staphylococcus aureus. 72.2 per cent of VAP patients had monomicrobial and 27.8 per cent had polymicrobial infection. Out of the 24 isolates obtained from patients with VAP, seven (29.2 per cent) were MDR pathogens. ESBL and MBL production was detected in 40 per cent and 20 per cent of Klebsiella pneumoniae isolated in our study. Around 50 per cent of isolates associated with late-onset VAP were MDR, while 22.2 per cent isolates obtained from patients with earlyonset VAP were MDR.
CONCLUSION
VAP is a nosocomial pneumonia that is common among ventilated patients. The aetiological agents vary from common organisms to MDR pathogens that are difficult to treat. A proper knowledge of MDR pathogens and early isolation followed by prevention of prolonged antibiotic therapy can reduce the mortality of late onset VAP.
背景
呼吸机相关性肺炎（VAP）是重症监护病房中常见的一种医院获得性肺炎。有多种病原体导致治疗具有挑战性。对接受机械通气的患者进行不恰当的抗生素治疗可能会导致多重耐药（MDR）病原体的出现。
方法
进行了一项为期20个月的前瞻性研究。我们的研究有两个分支：第一个，“三级医院VAP的发病率及危险因素”是一篇早期发表文章的主题；因此，我们在本研究中展示第二个调查分支。通过标准细菌学方法鉴定接受机械通气（MV）患者的病原体。采用 Kirby-Bauer 纸片扩散法评估药敏模式。采用组合纸片法进行超广谱β-内酰胺酶（ESBL）检测，采用EDTA纸片协同试验（EDS）进行金属β-内酰胺酶（MBL）检测。
结果
迟发性VAP与铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌有关，而早发性VAP通常由肠杆菌科成员、白色念珠菌和金黄色葡萄球菌引起。72.2%的VAP患者为单一微生物感染，27.8%为多微生物感染。在从VAP患者中分离出的24株菌株中，7株（29.2%）为MDR病原体。在我们的研究中，40%的肺炎克雷伯菌分离株检测到ESBL和MBL产生。约50%与迟发性VAP相关的分离株为MDR，而从早发性VAP患者中获得的分离株中有22.2%为MDR。
结论
VAP是一种在接受机械通气患者中常见的医院获得性肺炎。病原体从常见微生物到难以治疗的MDR病原体各不相同。正确了解MDR病原体并早期隔离，随后避免长期抗生素治疗，可以降低迟发性VAP的死亡率。
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