CSICU呼吸机相关性肺炎临床与病原学分析

Clinical analysis of etiology of ventilator-associated pneumonia in CSICU

目的监测心脏外科重症监护病房(CSICU)呼吸机相关性肺炎(VAP)的临床相关因素、病原菌分布及耐药性,探讨预防治疗VAP措施。方法对医院心脏外科术后行机械通气≥48h患者进行主动的目标性监测。结果 2009-2010年心脏外科术后发生VAP者180例、220例次,机械通气时间长、年龄≥60岁或<5岁、气管切开或反复气管插管均是发生VAP的相关因素;VAP检出病原菌286株,其中革兰阴性菌占62.94%,以鲍氏不动杆菌居首位,革兰阳性菌占16.78%,主要为中间葡萄球菌,真菌占20.28%,主要为白色假丝酵母菌;鲍氏不动杆菌对头孢哌酮、替卡西林/克拉维酸及头孢曲松等具有较高耐药性,耐药率分别为85.48%、70.97%、72.58%;革兰阳性菌对左氧氟沙星、万古霉素及替考拉宁等药物敏感性较高,敏感率>95.0%,对其他大多数药物耐药性较高,耐药率>60.0%。结论为了减少VAP,应尽量缩短机械通气时间,合理选用抗菌药物、加强无菌操作和消毒隔离措施。

OBJECTIVE To monitor the clinical associated factors and the distribution and drug resistance of pathogenic bacteria causing ventilator-associated pneumonia （VAP） in cardiac surgery intensive care unit （CSICU）, so as to propose the measures for the prevention and treatment of VAP. METHODS The initiative target monitoring of the patients who underwent mechanical ventilation for more than 48 hours after the cardiac surgery was performed. RESULTS Of the patients who underwent cardiac surgery from 2009 to 2010, VAP occurred in 180 patients with 220 case-times; long duration of mechanical ventilation, the age ≥60 years or 45 years, the tracheotomy or repeated tracheal intubation were the related factors for VAP; there were 286 strains of pathogens causing VAP isolated, of those pathogens, 62.94 % were gram-negative bacteria among which Acineto- bacter baumannii ranked the first place, 16.78% were gram-positive bacteria among which Staphylococcus was dominated, and 20. 28% were fungi among which Candida albicans was the main species; the drug resistance rates of A. baumannii to cefoperazone, ticarcillin/clavulanic acid and ceftriaxone were 85. 48%, 70. 92% and 72.58% the susceptibility rates of gram-positive bacteria to levofloxacin, vancomycin, and teicoplanin were higher than 95. 0%, and the drug resistance rates to most of the other antibiotics were less than 60. 0%. CONCLUSION To reduce the VAP, it is necessary to shorten the duration of mechanical ventilation, reasonably use antibiotics, and strengthen the aseptic operation as well as the disinfection and isolation.