金黄色葡萄球菌肺炎机械通气患者的临床流行病学调查

Pathogens and high risk factors of ventilator-associated pneumonia:a clinical and epidemiologic study

目的观察与机械通气相关金葡萄球菌肺炎的临床和流行病学特征。方法通过细菌培养和纸片扩散法检测金黄色葡萄球菌肺部感染情况,根据患者感染的病原学不同分为(甲氧西林金黄色葡萄球菌敏感和耐甲氧西林金黄色葡萄球菌)两组,比较治疗过程中患者的年龄、性别、原发疾病、意识状态,临床治疗时间。观察两组患者的病死率。结果与甲氧西林敏感性金黄色葡萄球菌机械通气相关肺炎比较,耐甲氧西林金黄色葡萄球菌肺炎患者在重症监护病房(ICU)治疗时间和插管时间延长,支气管镜检及其他致病微生物引起的既往肺炎、以及联合使用两种以上抗生素治疗史人数更多。结论 ICU工作的医务人员应严格执行无菌操作制度,减少呼吸机管路的交叉污染和不必要的支气管镜检查,尽可能缩短有创机械通气时间,争取早日拔管,同时保护现有的对耐甲氧西林金黄色葡萄球菌有效的药物。

Objective To observe the clinical and epldemiologic features of ventilator- associated Staphylococcus aureus pneumonia. Methods Staphylococcus aureus in patients with ventilator-associated Staphylococcus aureus pneumonia were detected using bacteria culture and disk diffusion method. According to the pathogens, the patients were divided into two groups： methicillin-sensitive group and methicillin-resistant group. Comparisons of gender,age, treatment for primary disease, state of consciousness and treatment time between the two groups were performed. The fatality rate of the two groups was also compared. Results Compared with the patients in methicillin-sensitive group, the patients in methicillin-resistant group had longer ICU treatment time and intubation time. Furthermore, the percentage of patients receiving bronchoscopy, with pneumonia caused by other pathogenic microorganisms and receiving a combination treatment with two or more antibiotics in the methicillin-resistant group was higher than that in the methicillin-sensitive group. Conclusion The medical staff in ICU should be strict in aseptic operation, so as to reduce the cross-infection from ventilator tube or unnecessary bronchoscopic examination. The mechanical ventilation time should be shortened as far as possible. Most importantly, the existing effective drugs for methicillin-resistant Staphylococcus aureus should be well protected.