心外科ICU脑膜败血性黄杆菌致呼吸机相关性肺炎危险因素及耐药性分析

Risk factors for ventilator-associated pneumonia caused by meningeal septic flavobacterium in cardiac ICU and analysis of drug resistance

目的探讨ICU脑膜败血性黄杆菌所致呼吸机相关性肺炎(VAP)危险因素及耐药性。方法采用回顾性调查方法,对2009-2011年心外科ICU 42例脑膜败血性黄杆菌所致VAP患者临床资料进行统计分析。结果 0～3岁患儿占80.95%,≥60岁患者占19.05%;机械通气天数平均≥1周,患者合并有≥3种侵入性操作;所有患者均有较长时间使用广谱抗菌药物史;脑膜败血性黄杆菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、磺胺甲噁唑/甲氧苄啶耐药率<5.0%,对庆大霉素、妥布霉素、哌拉西林、头孢噻肟耐药率>90.0%;部分呼吸机外置管道及附件采样监测出脑膜败血性黄杆菌。结论低龄、长时间入住ICU、机械通气时间较长、多种侵入性操作、广谱抗菌药物使用及呼吸机管道附件消毒是否彻底,是心外ICU患者发生脑膜败血性黄杆菌致VAP的危险因素;哌拉西林/他唑巴坦、头孢哌酮/舒巴坦是抗感染治疗的首选药。

OBJECTIVE To investigate the risk factors and etiology on ventilator-associated pneumonia caused by meningeal septic flavobacterium in cardiac ICU. METHODS By means of the retrospective review, the clinical data of 42 patients with ventilator-associated pneumonia caused by meningeal septic flavobacterium in cardiac ICU from 2009 to 2011 was statistically analyzed. RESULTS The children aged from 0 to 3 years old accounted for 80.95%, and the patients aged more than 60 years accounted for 19.05% ; the average duration of mechanical ventilation was no less than 1 week, and the patients underwent no less than three invasive operations; all of the patients had the long history of using broad-spectrum antimicrohial drugs; the drug resistance rates of Meningeal septic flavobacterium to piperacillin/tazobactam, cefoperazone sodium/sulbactam, and trimethoprim and sulphame- thoxazole were under 5.0 %, and the drug resistance rates to gentamicin, tobramyein, piperacillin, and cefotaxime were higher than 90.0%; part of the ventilatorsr external pipelines and attachments were detected the meningeal septic flavobacterium. CONCLUSION The young age, long stay in ICU, long duration of mechanical ventilation, multiple invasive operations, use of broad-spectrum antimicrobial drug, and the poor sterilization of the ventilators＇ external pipelines and attachments are the risk factors for ventilator-associated pneumonia caused by meningeal septic flavobacterium in cardiac ICU, and the piperacillin/tazobactam and cefoperazone sodium/ sulbactam are the preferred choice for the anti-infection therapy.