ICU呼吸机相关肺炎病原菌及多重耐药菌的危险因素分析

Analysis on the risk factors of pathogenic bacteria and multiple drug-resistant bacteria of ventilator-associated pneumonia

目的分析ICU(intensive care unit)住院患者呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)细菌种群变化及相关危险因素,指导多重耐药菌的临床治疗。方法回顾性分析2009年1月~2017年1月ICU住院患者419例VAP细菌感染资料,采用法国生物梅里埃ATB Expression微生物分析仪对细菌做鉴定及药敏试验,应用WHONET5软件及SPSS19.0进行数据统计分析。结果 2009~2017年的8年间共检测出革兰阴性菌323例,占77.1%,其中主要为鲍曼不动杆菌143例,占34.1%,铜绿假单胞菌68例(16.2%),肺炎克雷伯杆菌57株(13.6%),大肠埃希菌49例(11.7%),其他阴性菌6例(1.43%);革兰阳性菌96例,占23%,其中金黄色葡萄球菌31例(7.4%)。其多重耐药感染高危因素有住院时间延长(入住ICU≥3 d),APACHEⅡ急性生理与慢性健康评分(acute physiology and chronic health evaluation)>15、插管包括经鼻胃管、中心静脉插管,机械通气≥2 d,接受抗菌药物广泛使用等。结论重症医学科VAP感染多重耐药性细菌以革兰阴性菌为主,导致多重耐药影响因素较多,机械通气时间、抗菌药物联合使用、APACHEⅡ>15都是高危因素,ICU重症患者应控制相关因素,减少多重耐药菌的产生。

Objective To analyze the changes of bacterial population of ventilator-associated pneumonia and the related risk factors in inpatients in ICU, so as to guide the clinical treatment of multi-resistant bacteria. Methods The data of419 ICU inpatients with VAP bactieral infection from January 2009 to January 2017 were retrospectively analyzed. The French Bio Mérieux ATB Expression Microbial Analyzer was used to carry out identification and susceptibility testing of bacteria, and WHONET5 software and SPSS19.0 were used for statistical analysis of data. Results A total of 323 Gram-negative bacteria were detected in 8 years from 2009 to 2017, accounting for 77.1%. Among them, Acinetobacter baumannii 143 cases, accounting for 34.1%; Pseudomonas aeruginosa 68 cases（16.2%）; Klebsiella pneumoniae 57 cases（13.6%）; Escherichia coli 49 cases（11.7%）; Other negative bacteria 6 cases（1.43%）; Gram-positive bacteria 96 cases,accounting for 22.9%; Staphylococcus aureus 31 cases（7.4%）. The risk factors for multiple drug resistant infections were prolonged hospital stay（ ICU admission ≥ 3 days）, APACHE Ⅱ Acute Physiology and Chronic Health Score15,intubation, including nasogastric tube, central venous catheter, mechanical ventilation ≥2 days, receiving widespread use of anti-bacterial drugs, etc. Conclusion Gram-negative bacteria are the main multi-drug resistant bacteria of VAP infection in the department of critical medicine, resulting in many factors affecting multi-drug resistance. Mechanical ventilation time, combined use of antimicrobial agents, APACHEⅡ 〉15 are all risk factors. Critically ill patients admitted in ICU should control the relevant factors to reduce the generation of multi-resistant bacteria.