ICU呼吸机相关性肺炎流行病学特征、病原菌谱及危险因素分析  

Analysis of epidemiologic characteristics,pathogenic bacteria spectrum and risk factors of ventilatorassociated pneumonia in ICUs

作　　者：陈艳 潘殿柱 王波 李阳 赵欢 CHEN Yan;PAN Dianzhu;WANG Bo;LI Yang;ZHAO Huan(Respiratory Ward III of the First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,Liaoning,China)

机构地区：[1]锦州医科大学附属第一医院呼吸三病区,辽宁锦州121000

出　　处：《中国病原生物学杂志》2025年第3期282-286,291,共6页Journal of Pathogen Biology

摘　　要：目的探究医院2022-2023年ICU重症监护中心呼吸机相关性肺炎(VAP)的流行病学特征、病原菌谱及分析危险因素。方法回顾性分析1236例ICU重症监护患者临床资料,按VAP发生情况分为VAP组(n=63)与非VAP组(n=1173),分析ICU重症监护中心VAP的流行病学特征、病原菌谱,对比两组基线资料,采用二元Logistic回归分析ICU重症监护中心VAP发生的危险因素。结果63例ICU重症监护中心VAP患者发病率为5.19%机械通气日,主要发生于>60岁、合并糖尿病、合并脑血管疾病、呼吸机使用时间5d、留置胃管、预防性使用抗生素、抑酸剂使用时间>3d、使用糖皮质激素、低蛋白血症。ICU重症监护中心VAP患者检出病原菌104株,其中革兰阳性菌37株(58.73%),最主要的是金黄色葡萄球菌、表皮葡萄球菌;革兰阴性菌61株(96.83%),最主要的是鲍曼不动杆菌、肺炎克雷伯菌;真菌6株(9.52%)。金黄色葡萄球菌主要耐药药物为青霉素、克林霉素、苯唑西林;表皮葡萄球菌主要耐药药物为青霉素、红霉素、克林霉素、苯唑西林;鲍曼不动杆菌主要耐药药物为头孢他啶、哌拉西林、氨曲南;肺炎克雷伯菌主要耐药药物为环丙沙星、氨曲南、左氧氟沙星。二元Logistic回归模型中分析显示,合并糖尿病、脑血管疾病、留置胃管、预防性使用抗生素、抑酸剂使用时间(>3d)、使用糖皮质激素、低蛋白血症均是ICU重症监护中心VAP发生的危险因素(P<0.05)。结论2022-2023年ICU重症监护中心VAP主要病原菌为革兰阴性菌,存在多种药物耐药,临床需合理应用抗菌药物;合并糖尿病、脑血管疾病、留置胃管、预防性使用抗生素、抑酸剂使用时间(>3d)、使用糖皮质激素、低蛋白血症均是ICU重症监护中心VAP发生的危险因素。Objective To investigate the epidemiological characteristics,pathogenic bacterial spectrum and analyze the risk factors of ventilator-associated pneumonia(VAP)in ICU intensive care centers in hospitals from 2022-2023.Methods The clinical data of 1,236 ICU intensive care patients were retrospectively analyzed and divided into the VAP group(n=63)and the non-VAP group(n=1173)according to the occurrence of VAP,and the epidemiological characteristics and pathogenic bacterial spectrum of VAP in ICU intensive care centers were analyzed to compare the baseline data of the two groups,and binary Logistic regression was used to analyze the risk factors for the occurrence of VAPinICUintensivecarecenters.ResultsThe incidence rate of 63 patients with VAP in ICU intensive care center was 5.19%o mechanical ventilation days,which mainly occurred in>60 years old,combined diabetes mellitus,combined cerebrovascular disease,ventilator use≥5 d,indwelling gastric tube,prophylactic antibiotic use,acid suppressant use>3 d,use of glucocorticosteroids,and hypo-proteinemia.104 strains of pathogenic bacteria were detected in patients with VAP in ICU intensive care centers,of which 37 strains of Gram-positive bacteria(including Gram-positive bacteria)were detected.Among them,37 strains(58.73%)of Gram-positive bacteria,most predominantly Staphylococcus aureus and Staphylococcus epidermidis;61 strains(96.83%)of Gram-negative bacteria,most predominantly Acinetobacter baumanni and Klebsiella pneumoniae;and 6 strains(9.52%)of fungi.The main resistant drugs for Staphylococcus aureus were penicillin,clindamycin,and benzoziline;for Staphylococcus epidermidis,penicillin,erythromycin,clindamycin,and benzoriline;for Acinetobacter baumanni,ceftazidime,piperacillin,and amitraz;and for Klebsiella pneumoniae,ciprofloracin,amitrazine,and levofloxacin.Analysis in the binary logistic regression model showed that comorbid diabetes,cerebrovascular disease,indwelling gastric tube,prophylactic use of antibiotics,duration of acid suppression(>3 d),use of glucocor

关 键 词：呼吸机相关性肺炎 重症监护中心 流行病学特征 病原菌谱 危险因素 

分 类 号：R47[医药卫生—护理学]