ICU呼吸机相关肺炎患者的影响因素及病原学特点分析  

Risk factors and pathogenic bacteria characteristic analysis of ICU ventilator associated pneumonia

作　　者：刘卫平 郭天慧 李昊雪 杨永芳 赵宇平 张凯 海云婷 姚星 LIU Wei-ping;GUO Tian-hui;LI Hao-xue;YANG Yong-fang;ZHAO Yu-ping;ZHANG Kai;HAI Yun-ting;YAO Xing(Inner Mongolia People＇s Hospital , Huhhot, Inner Mongolia 010010, China)

机构地区：[1]内蒙古自治区人民医院医院感染控制科,内蒙古呼和浩特010010

出　　处：《中华医院感染学杂志》2018年第8期1191-1194,共4页Chinese Journal of Nosocomiology

基　　金：中国医院协会基金资助项目(CHA-2016-026-053);内蒙古自治区人民医院基金资助项目(2016060)

摘　　要：目的了解ICU中呼吸机相关肺炎(VAP)发生的影响因素、病原菌的分布、耐药性特点,为预防VAP和抗菌药物的应用提供指导。方法回顾性调查2016年9月-2017年3月入住医院ICU接受呼吸机通气的209例患者,对下呼吸道痰标本分离到的病原菌进行鉴定和药敏学分析,以Logistic回归分析VAP发生的影响因素。结果 209例患者中发生VAP的73例,VAP发生率为34.93%,VAP患者痰标本共分离出304株病原菌,其中革兰阴性菌266株占87.50%、革兰阳性菌38株占12.50%;鲍氏不动杆菌对多数抗菌药物耐药,耐药率均>90%;铜绿假单胞菌对碳青霉烯类、氨基糖苷类抗菌药物的耐药率较低,均<15%;金黄色葡萄球菌对青霉素、头孢西丁、红霉素的耐药率为100.00%;Logistic回归分析结果显示,年龄66~80岁、机械通气时间>5d、COPD、APACHEⅡ评分>15分、意识状态模糊、使用抑酸药物为发生VAP的影响因素。结论对VAP发生的相关影响因素应实行重点监控并积极避免,革兰阴性菌是ICU导致VAP的主要病原菌,且对多种抗菌药物耐药,应根据病原学及药敏结果合理用药。OBJECTIVE To understand the risk factors, distribution of pathogenic bacteria and characteristics of drug resistance of ventilator associated pneumonia （VAP） in the intensive care unit （ICU）, so as to provide guid- ance for the prevention of VAP and the application of antimicrobial agents. METHODS A total of 209 cases pa- tients with ventilators in the ICU from Sep. 2016 to Mar. 2017 were retrospectively analyzed. The pathogenic bac- teria isolated from the sputum of the lower respiratory tract were used for identification and pharmacological anal- ysis. The risk factors of VAP were analyzed by logistic regression analysis. RESULTS There were 73 cases of VAP among 209 patients, and the incidence of VAP was 34.92%. Totally 304 strains of pathogenic bacteria were isola- ted from the sputum specimens of VAP patients, including 266 strains of gram-negative bacteria, aceountipg for 87.50 %, 38 strains of gram-positive bacteria, accounting for 12.50%. Acinetobacter baumannii was resistant to most antibiotics, and the resistant rates were higher than 90%. The resistant rates of Pseudomonas aeruginosa to carbapenems and aminoglycoside antibiotics were low, which were all lower than 15%. The resistant rates of Staphylococcus aureus to penicillin, erythromycin and cefoxitin were 100.00%. The logistic regression analysis re- sults showed that age of 66 ~80 years old, mechanical ventilation time〉5 d, COPD, APACHE Ⅱ score〉15,consciousness and the use of acid suppression drugs were the risk factors of VAP. CONCLUSION The occurrence of VAP associated risk factors should be monitored and actively avoid, gram-negative bacteria is the leading cause of VAP pathogenic bacteria in ICU, and is resistant to many kinds of antimicrobial agents, so we should rationally use drug according to the etiology and drug susceptibility results.

关 键 词：ICU VAP 影响因素 病原学 药敏试验 

分 类 号：R563.1[医药卫生—呼吸系统]