呼吸机相关肺炎患者病原学特点及影响因素分析

Etiological characteristics of patients with ventilator-associated pneumonia and influencing factors

目的回顾性分析呼吸机相关肺炎病原学特点及影响因素,旨在为临床提供参考。方法选取医院2013年9月-2016年9月收治的ICU应用呼吸机患者600例,统计呼吸机相关肺炎发生率,分析感染病原菌分布及耐药情况,分析呼吸机相关肺炎相关影响因素。结果共发生呼吸机相关肺炎78例,发生率为13.00%;78例呼吸机相关肺炎患者共培养出病原菌86株,其中革兰阴性菌63株、占73.26%,革兰阳性菌19株、占22.09%,真菌4株、占4.65%;革兰阴性菌对头孢唑林、头孢噻肟、头孢他啶、庆大霉素耐药率较高,对美罗培南、莫西沙星、环丙沙星、阿米卡星耐药率较低;革兰阳性菌对青霉素G、红霉素、环丙沙星、左氧氟沙星耐药率较高,对万古霉素、磺胺甲噁唑/甲氧芐啶耐药率较低;年龄>60岁、机械通气时间>5d、气管切开、APACHE II评分≥15分、使用制酸剂为呼吸机相关肺炎独立危险因素。结论引起呼吸机相关肺炎发生的危险因素较多,临床上需针对危险因素进行预防,同时进行病原学分析,合理应用抗菌药物,从而有效降低呼吸机相关性肺炎发病率。

OBJECTIVE To retrospectively analyze the etiological characteristics of ventilator-associated pneumonia（VAP）and analyze the influencing factors so as to provide guidance for clinical treatment.METHODS A total of600 ICU patients who were treated with ventilators from Sep 2013 to Sep 2016 were enrolled in the study.The incidence of VAP was statistically analyzed,the distribution and drug resistance of pathogens causing infections were analyzed,and the influencing factors for the VAP were observed.RESULTS Totally 78 patients had VAP,with the incidence rate 13.00%.A total of 86 strains of pathogens were isolated from the 78 patients with VAP,of which 63（73.26%）were gram-negative bacteria,19（22.09%）were gram-positive bacteria,and 4（4.65%）were fungi.The gram-negative bacteria were highly resistant to cefazolin,cefotaxime,ceftazidime and gentamicin,however,the drug resistance rates to meropenem,moxifloxacin,ciprofloxacin and amikacin were low.The grampositive bacteria were highly resistant to penicillin G,erythromycin,ciprofloxacin and levofloxacin,however,the drug resistance rates to vancomycin and sulfamethoxazole-trimethoprim were low.The independent risk factors for the VAP included the more than 60 years of age,mechanical ventilation duration more than 5 days,tracheotomy,APACHE II score no less than 15 points and use of antacids.CONCLUSIONThere are a variety of risk factors for the VAP,it is necessary for the hospital to take prevention measures aiming at the risk factors,conduct the etiological analysis and reasonably use antibiotics so as to effectively reduce the incidence of VAP.