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目的了解呼吸机相关性肺炎细菌耐药性及耐药基因分子流行病学特征,为临床诊疗提供参考。方法对呼吸机相关肺炎(VAP)病原菌构成进行分析,采用纸片扩散法检测主要致病菌耐药情况,采用脉冲场凝胶电泳(PFGE)进行主要病原菌的同源性和分子分型研究。结果 572例机械性通气患者中VAP患者247例(占43.18%);共分离致病菌359株,其中革兰阴性菌为231株(64.35%),革兰阳性菌52株(14.48%),真菌76株(21.17%);所有致病菌中,铜绿假单胞菌是主要致病菌,为102株(占28.41%)。铜绿假单胞菌对头孢唑啉和头孢克洛完全耐药,对利福平、氟氯西林的耐药率为98.04%。铜绿假单胞菌共有19个基因型(A~R),在各基因型中,A型有37株(36.28%),B型9株(8.82%),C型6株(5.89%),D型6株(5.89%),E型5株(4.90%)。结论 VAP主要致病菌存在优势克隆株流行,需要加强耐药性检测,预防暴发流行。
Objective To understand the bacterial resistance of drug-resistant pneumonia associated with ventilator-associated pneumonia and molecular epidemiology of drug resistance genes, and to provide a reference for clinical diagnosis and treatment. Methods The pathogens of ventilator-associated pneumonia (VAP) were analyzed. The drug resistance of major pathogens was detected by disk diffusion method. The homology and molecular typing of major pathogenic bacteria were studied by pulsed-field gel electrophoresis (PFGE). Results Among 572 patients with mechanical ventilation, 247 were VAP patients (43.18%), 359 were isolates of pathogenic bacteria, of which 231 (64.35%) were Gram-negative and 52 (14.48%) were Gram- 76 strains of fungi (21.17%), Pseudomonas aeruginosa was the main pathogenic bacteria of all pathogens, 102 (28.41%). Pseudomonas aeruginosa cefazolin and cefaclor completely resistant to rifampicin, flucloxacillin resistance rate was 98.04%. There were 19 genotypes (A ~ R) of Pseudomonas aeruginosa, among which 37 (36.28%) were type A, 9 (8.82%) were type B and 6 (5.89% 6 strains of D (5.89%), 5 strains of E (4.90%). Conclusion The dominant pathogens of VAP are prevalent in the presence of clonal strains and need to be tested for drug resistance to prevent outbreaks.