ICU呼吸机相关性肺炎合并碳青霉烯类耐药鲍曼不动杆菌及肺炎克雷伯菌感染的一般特征分析  

General characteristics analysis of ICU ventilator-associated pneumonia complicated with carbapenemresistant Acinetobacter baumannii and carbapenem resistant Klebsiella pneumoniae infections

作　　者：余锋 夏吉林 刘建 YU Feng;XIA Jilin;LIU Jian(Department of Intensive Care Medicine,Changshou District People′s Hospital,Chongqing 401228,China;Department of Intensive Care Medicine,Youyang County People′s Hospital,Chongqing 409899,China)

机构地区：[1]重庆市长寿区人民医院重症医学科,重庆401228 [2]重庆市酉阳县人民医院重症医学科,重庆409899

出　　处：《现代医药卫生》2025年第3期584-587,593,共5页Journal of Modern Medicine & Health

基　　金：重庆市科卫联合医学科研项目(2022MSXM113、2022QNXM010)。

摘　　要：目的 分析重症监护病房(ICU)呼吸机相关性肺炎(VAP)与非VAP(non-VAP)患者临床特征与病原学的差异,探寻VAP相关耐药菌感染的特征。方法 将2023年全年入住重庆市长寿区人民医院ICU并进行机械通气的288例患者纳入研究队列,其中70例患者呼吸道病原学培养阳性并诊断为肺炎,根据机械通气后第1次送检病原学的检查结果与机械通气开始时间的关系分为VAP队列(31例)和non-VAP队列(39例)。通过电子病历系统回顾性收集患者一般资料、生命体征、临床特征、病原学特征及耐药情况并进行对比分析。结果 VAP队列患者联合应用抗生素治疗例数明显少于non-VAP队列,年龄、呼吸频率、ICU病死率均明显高于non-VAP队列,差异均有统计学意义(P<0.05)。VAP队列患者感染菌株以鲍曼不动杆菌、肺炎克雷伯菌为主,其中碳青霉烯类耐药鲍曼不动杆菌7例,碳青霉烯类耐药肺炎克雷伯菌6例。non-VAP队列则以鲍曼不动杆菌、真菌感染为主。结论 高龄、未联合应用抗生素治疗是引起ICU患者发生VAP的危险因素,VAP患者将出现呼吸频率加快的临床症状并增加ICU病死率。VAP合并耐药菌(碳青霉烯类耐药鲍曼不动杆菌、碳青霉烯类耐药肺炎克雷伯菌)感染将带来更为严重的不良预后。Objective To analyze the clinical characteristics and pathogenic differences between ventilator-associated pneumonia(VAP)and non-VAP patients in the intensive care unit(ICU),and explore the characteristics of VAP related drug-resistant bacterial infections.Methods A total of 288 patients who were admitted to the ICU of Changshou District People′s Hospital in Chongqing for mechanical ventilation throughout 2023 were included in the study cohort.Among them,70 patients had positive respiratory pathogen culture and were diagnosed with pneumonia.According to the relationship between the results of the first pathogen test after mechanical ventilation and the start time of mechanical ventilation,they were divided into VAP cohort(31 cases)and non-VAP cohort(39 cases).Retrospective collection of general information,vital signs,clinical features,pathogen characteristics,and drug resistance status of the included samples through an electronic medical record system,and comparative analysis.Results The number of patients in the VAP cohort receiving combined antibiotic treatment was significantly lower than those in the non-VAP cohort.Age,respiratory rate,and ICU mortality rate were significantly higher than those in the non-VAP cohort,and the differences were statistically significant(P<0.05).The infection strains of VAP queue patients are mainly Acinetobacter baumannii and Klebsiella pneumoniae,among which there are 7 cases of carbapenem resistant Acinetobacter baumannii and 6 cases of carbapenem resistant Klebsiella pneumoniae.The non-VAP queue is mainly infected with Acinetobacter baumannii and fungi.Conclusion Advanced age and lack of combined antibiotic treatment are risk factors for VAP in ICU patients,who may experience clinical symptoms of increased respiratory rate and increased ICU mortality.VAP combined with drug-resistant bacteria(carbapenem resistant Acinetobacter baumannii and carbapenem resistant Klebsiella pneumoniae)infection will bring more serious adverse prognosis.

关 键 词：呼吸机相关性肺炎 重症监护病房 鲍曼不动杆菌 肺炎克雷伯菌 细菌感染 细菌抗药性 

分 类 号：R563.19[医药卫生—呼吸系统] R969.3[医药卫生—内科学]