目的分析并比较综合性重症监护病房(CICU)和急诊重症监护病房(EICU)早发性呼吸机相关性肺炎(EOP)患者下呼吸道分离的病原菌分布及多重耐药菌(MDRB)比例.方法选择CICU和EICU接受有创机械通气治疗的患者,采用一次性无菌痰标本采集管和无菌集痰器或纤维支气管镜经气管插管或气管切开套管采集下呼吸道分泌物标本,即时送检进行细菌培养及药敏试验,并对两组患者病原菌构成及MDRB比例进行比较.结果在CICU中EOP发生率12.8%,MDRB比例为50.4%,非发酵菌属及念珠菌属是主要的病原菌；而在EICU中,EOP发生率7.9%,MDRB比例仅为8.3%,表皮葡萄球菌、金黄色葡萄球菌、大肠埃希菌是主要病原菌.两组患者MDRB发生率的差异具有统计学意义(P<0.01).结论呼吸机相关性肺炎(VAP)的病原菌类型是由多种因素综合决定的,而不是由VAP发生时间的早晚所决定的.%Objective To investigate the distribution of pathogens and ratio of multidrug resistant bacteria (MDRB) sepa-rated from lower respiratory tract of early-onset ventilator-associated pneumonia (VAP) patients in comprehensive intensive care unit (CICU) and emergency intensive care unit (EICU). Methods The lower respiratory tract secretions specimens of EOP pa-tients in CICU and EICU were col ected by using disposable sterile sputum specimen col ection tubes and sterile sputum set or fiber bronchoscope through the endotracheal tube or tracheostomy tube from July 2008 to December 2011. The specimens were immediately sent for bacterial culture and sensitivity test; the distribution of pathogens and ratio of MDRB were compared be-tween two groups. Results In CICU the Gram-negative bacteria, especially non-fermentative bacteria were the main pathogens, the ratio of MDRB was 50.4%;in EICU the Gram-positive bacteria, especial y Staphylococcus epidermidis, Staphylo-coccus aureus, Escherichia coli were the main pathogens, the ratio of MDRB was 8.3%. There were significant differences in the distribution characteristics and MDRB ratio of pathogens between two groups. Conclusion The pathogens isolated from VAP patients are determined by the various factors, not the type of VAP.
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