重症监护室呼吸机相关肺炎患者的病原菌特征与耐药性及相关因素分析

Characteristics,drug resistance and related factors of ventilator-associated pneumonia in ICU

目的探讨重症监护室(ICU)呼吸机相关性肺炎(VAP)的病原菌特征与耐药性及相关因素。方法选择2015年3月-2017年3月期间医院ICU收治的机械辅助性呼吸超过48h的患者380例,诊断患者是否发生VAP,统计分析VAP患者的病原菌分布特点、主要病原菌的耐药性,采用SPSS 20.0软件分析影响VAP发生的相关因素。结果 380例患者中,有159例患者发生VAP,占41.84%;159例感染患者中共分离出263株病原菌,以革兰阴性菌为主,共179株占68.06%;鲍氏不动杆菌对哌拉西林耐药率最高;单因素分析结果显示,年龄≥60岁、合并糖尿病、昏迷、机械通气时间>5d、住院时间>14d、使用糖皮质激素、留置胃管、抗菌药物使用种类>3种能够显著影响VAP的发生(P<0.05)。结论 VAP病原菌以革兰阴性菌为主,合理选择抗菌药物并针对相关因素加强管理,控制VAP发生率。

OBJECTIVE To investigate the characteristics, drug resistance and related factors of ventilator-associated pneumonia （VAP） in ICU. METHODS A total of 380 cases who received mechanically assisted breathing ≥48h in ICU from Mar. 2015 to Mar. 2017 were included in the study. VAP was diagnosed. The distribution characteristics of pathogens, and drug resistance of main pathogenic bacteria were analyzed. SPSS 20 software was used to analyze the related factors of the occurrence of VAP. RESULTS Totally 159 cases of VAP occurred among 380 patients, accountinf for 41.84%. Totally 263 strains of pathogenic bacteria were isolated. Among them, there were 179 strains of gram-negative bacteria, accounting for 68.06%. The resistant rate of Acinetobacter baumannii to piperacillin was the highest. Univariate analysis results showed that, ages≥60, diabetes, coma, mechanical venti- lation〉5d, hospitalization time〉 14d, corticosteroids, indwelling gastric tube, and antibiotics〉 3 could significantly affect the occurrence of VAP （P〈0.05）. CONCLUSION VAP pathogens are mainly gram-negative bacteria. Rational selection of antibiotics and management of related factors must be strengthened to control the incidence of VAP.