黄杆菌致老年人呼吸机相关性肺炎的危险因素和防治策略

Ventilator-associated pneumonia caused by flavobacterium in elderly patients： risk factors and prevention strategy

目的探讨黄杆菌致老年人呼吸机相关性肺炎（VAP）的危险因素和防治策略。方法对黄杆菌VAP的老年患者进行前瞻性研究，分析该菌感染的危险因素和耐药结果。结果112例患者均有严重的基础疾病，多为混合感染，病死率高。长期住院、β内酰胺类抗生素的使用不合理、建立人工气道、各种呼吸道侵入性操作及机械通气、反流误吸是该菌感染的危险因素。黄杆菌对大多数抗生素耐药，仅有利福平、哌拉西林／他唑巴坦、头孢哌酮／舒巴坦、万古霉素的耐药率低于40．0％，依次为20．8％、19．7％、14．8％、3．8％。结论黄杆菌VAP属于晚发性VAP，其缺乏特异性的临床特征，对有该菌感染危险因素的老年患者应加强检测，针对内外源性感染途径采取相应性预防措施，治疗可采用头孢哌酮／舒巴坦和万古霉素的联合用药。

Objective To investigate the risk factors, prevention and treatment strategy for elderly ventilator-associated pneumonia （VAP） caused by flavobacterium. Methods Prospective study was held on 112 elderly patients with VAP caused by flavobacterium. The data of clinical materials and antimicrobial resistance were collected. Results All the patients were suffered from serious underlying diseases, most patient were mixed infection and the mortality was high. Prolonged hospitalization and inappropriate use of beta-lactam antibiotics, intratracheal intubation or tracheotomy and various invasive operation in airway, mechanical ventilation, backstreaming and aspiration of gastric contents were risk factors. The drug sensitivity tests showed that these strains were multiresistant to most kinds of antibiotics, and drugs, which resistant rates were under 40. 0%, included rifampin （ 20. 8 %）, piperacillin/tazobactam （ 19.7 %）, cefoperazone/sulbactam （ 14.8 % ）, vancomycin（ 3. 8%）. Conclusions VAP caused by flavobacterium occurs in later time of ventilation. These strains are highly resistant, and the prevention and surveillance are very important. Cefoperazone/sulbactam and vancomycin should be first chosen to treat infection caused by flavobacterium.