急诊重症监护病房机械通气相关性肺炎患者病原菌耐药性及死亡因素分析

Analysis of pathogenic bacteria resistance and risk factors of death on ventilator-associated pneumonia pa-tients in emergency intensive care unit

目的：分析急诊重症监护病房（EICU）中机械通气相关性肺炎（VAP）患者临床特点、病原菌分布及耐药性特点，探讨导致VAP患者死亡的危险因素。方法对浙江省嘉兴市第二医院2010年6月至2013年5月收治的190例VAP患者的临床资料作回顾性分析，分析患者的临床特点、病原菌的分布及耐药性以及死亡危险因素。结果190例VAP患者分离革兰阴性菌184株（76．0％），其铜绿假单胞菌74株（40．2％）和大肠埃希菌70株（38．0％）最为常见。铜绿假单胞菌对阿米卡星、亚胺培南/西司他丁敏感率最高，分别为77．0％（57/74）、73．0％（54/74），而大肠埃希菌对头孢他啶、亚胺培南/西司他丁敏感率均为71．4％（50/70）。年龄≥60岁[比值比（OR）＝6．675，95％置信区间（CI）：2．620～9．731]、累及器官≥3个[OR＝3．225，95％CI：1．337～7．806]及营养治疗不充分[OR＝1．912，95％CI：1．043～8．522]是VAP患者死亡的危险因素。结论 EICU中VAP病原菌以革兰阴性菌为主。多器官功能受损、营养不良是导致VAP患者死亡的主要危险因素。

Objective To analyze the clinical characteristics of ventilator-associated pneumonia （ VAP） in patients admitted to the emergency intensive care unit （ EICU） , pathogen distribution and drug resistance char-acteristics;to explore the risk factors for death in VAP patients .Methods The clinical data of 190 cases of VAP patients from June 2012 to May 2013 in the Second Hospital of Jiaxing city , were retrospectively analyzed .Clinical characteristics , distribution and drug resistance of pathogenic bacteria and death risk factors of death were ana -lyzed.Results Two hundred and forty-two strains of pathogens were isolated from 190 patients, with 184 strains of Gram-negative bacteria.74 Pseudomonas aeruginosa （40.2%） and 70 Escherichia coli （38.0%） were most com-mon pathogenic bacteria in Gram-negative bacilli.Antibiotic sensitive rate of Pseudomonas aeruginosa was 77.0%（57/74） and 73.0%（54/70） to amikacin and imipenem/cilastatin sodium.Antibiotic sensitivity rate of Esche-richia coli was 71.4%to ceftazidime and imipenem/cilastatin sodium.Age≥60 years [odds ratio （OR）=6.675, 95%confidence interval （CI）：2.620-9.731], the cumulative organ ≥3[OR=3.225, 95%CI：1.337-7.806] and lack of nutrition therapy [OR=1.912, 95% CI： 1.043-8.522] were death risk factors for VAP patients . Conclusions Gram-negative bacteria are the main pathogenic bacteria of VAP patients in EICU .Comprehensive treatment should be applied to treat complicated multiple organ dysfunction and malnutrition to reduce VAP mortality.