ICU呼吸机相关性肺炎危险因素、病原菌分布及耐药性分析  

Analysis of Risk Factors, Pathogen Distribution and Drug Resistance of Ventilator-associated Pneumonia in ICU

作　　者：龙淑珍[1] 郭靖[1] 黎艳[2] 蓝丹 黄辛[1] 檀倩影[1] LONG Shuzhen;GUO Jing;LI Yan;LAN Dan;HUANG Xin;TAN Qianying(Guangxi Health Vocational and Technical College,Nanning 530023,China;不详)

机构地区：[1]广西卫生职业技术学院,广西南宁530023 [2]广西壮族自治区人民医院

出　　处：《中国医学创新》2022年第4期108-112,共5页Medical Innovation of China

基　　金：2020年度广西高校中青年教师科研基础能力提升项目(2020KY43003)。

摘　　要：目的:分析重症医学科(intensive care unit,ICU)住院患者呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的危险因素、病原菌分布及耐药性。方法:回顾性分析2019年1月-2020年8月南宁市某医院ICU接受机械通气的128例患者的临床资料,其中64例发生VAP的患者作为观察组,64例未发生VAP的患者作为对照组。对比两组临床资料,分析VAP相关影响因素、病原菌分布及药物敏感试验结果。结果:观察组气管切开、慢性阻塞性肺疾病(COPD)、低蛋白血症、机械通气≥7 d、抗菌药物治疗≥7 d、联合应用抗菌药物≥3种比例均高于对照组,差异均有统计学意义(P<0.05)。气管切开、COPD、机械通气≥7 d、抗菌药物治疗≥7 d、联合应用抗菌药物≥3种均为发生VAP的危险因素(P<0.05)。64例VAP患者通过痰培养共检出病原菌56株,其中革兰阴性菌47株(83.9%),革兰阳性菌6株(10.7%),真菌3株(5.4%)。前三位病原菌为鲍曼不动杆菌、肺炎克雷伯氏菌肺炎亚种及铜绿假单胞菌,构成比分别为37.5%、25.0%、14.3%。鲍曼不动杆菌对多数抗菌药物耐药率高(>80%),对头孢唑啉的耐药率为100%,对米诺环素和头孢噻肟的耐药率较低。肺炎克雷伯菌肺炎亚种对头孢呋辛的耐药率最高(92.9%),对庆大霉素、亚胺培南、头孢他啶、米诺环素的耐药率较低。铜绿假单胞菌对头孢唑啉耐药率为100%,对磷霉素耐药率较低。结论:气管切开、COPD、机械通气≥7 d、抗菌药物治疗≥7 d、联合应用抗菌药物≥3种均为ICU患者发生VAP的危险因素,临床应重点关注VAP高危人群,制定针对性措施。VAP主要病原菌为革兰阴性菌,对大部分常用抗菌药物耐药率较高,致病菌培养及药敏试验有助于选择正确的抗菌药物。Objective:To analyze the risk factors,pathogen distribution and drug resistance of ventilator-associated pneumonia (VAP) in hospitalized patients in intensive care unit (ICU).Method:The clinical data of 128 patients receiving mechanical ventilation in ICU of a hospital in Nanning city from January 2019 to August 2020 were retrospectively analyzed,including 64 patients with VAP as the observation group and 64 patients without VAP as the control group.The clinical data of the two groups were compared,and VAP related factors,pathogen distribution and drug sensitivity test results were analyzed.Result:The proportions of tracheotomy,chronic obstructive pulmonary disease (COPD),hypoproteinemia,mechanical ventilation ≥7 d,antibiotic treatment ≥7 d,combined antibiotic treatment ≥3 in the observation group were higher than those in the control group,and the differences were statistically significant (P<0.05).Tracheotomy,COPD,mechanical ventilation ≥7 d,antibiotic treatment ≥7 d,combined antibiotic treatment ≥3 were risk factors for VAP (P<0.05).A total of 56 strains of pathogenic bacteria were detected from 64 VAP patients by sputum culture,including 47 strains of Gram-negative bacteria (83.9%),6 strains of Gram-positive bacteria (10.7%) and 3 strains of fungi (5.4%).The top three pathogens were Acinetobacter baumannii,Klebsiella pneumoniae subspecies pneumoniae and Pseudomonas aeruginosa,with composition ratios of 37.5%,25.0% and 14.3%,respectively.The resistance rates of Acinetobacter baumannii to most antibacterial drugs were high (>80%),the resistance rate to Cefazolin was 100%,and the resistance rates to Minocycline and Cefotaxime were low.The drug resistance rate of Klebsiella pneumoniae subspecies to Cefuroxime was highest (92.9%),and the drug resistance rates to Gentamicin,Imipenem,Ceftazidime and Minocycline were lower.The drug resistance rate of Pseudomonas aeruginosa to Cefazolin was 100%,and the drug resistance rate to Fosfomycin was low.Conclusion:Tracheotomy,COPD,mechanical ventilation ≥7 d,ant

关 键 词：ICU 呼吸机相关性肺炎 病原菌 耐药性 

分 类 号：R563.1[医药卫生—呼吸系统] R446.5[医药卫生—内科学]