呼吸机相关性肺炎病原菌分布及其危险因素分析

Analysis of the risk factors and pathogenic bacteria distribution of ventilator-associated pneumonia

目的分析2015年9月~2016年8月安徽医科大学第一附属医院使用呼吸机患者的病原菌感染分布及耐药性情况,为早期预防和治疗呼吸机相关性肺炎提供参考依据。方法回顾性分析2015年9月1日~2016年8月31日于安徽医科大学第一附属医院住院治疗期间使用呼吸机患者的临床资料,探讨病原菌分布特点及其耐药情况。结果共计751人次使用呼吸机,分离病原菌菌株为303株,样本标本主要来源于痰(81.85%)、血液(6.93%)、尿液(2.64%)。其中,革兰阴性菌、革兰阳性菌、真菌分别占84.61%、6.93%和8.91%;药敏实验结果表明,革兰阴性菌中占前四位的依次为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌,革兰阳性菌主要以金黄色葡萄球菌为主。呼吸机相关性肺炎相关危险因素主要包括患者留置胃管、抗生素应用超过3种、机械通气及重症监护治疗病房住院日的延长。结论接受呼吸机治疗的患者所感染病原菌以革兰阴性菌为主,了解病原菌的耐药特点及相关危险因素,为临床选择抗菌药物提供参考依据和指导。

Objective To analyze pathogenic bacteria distribution and risk factors of ventilator-associated pneumo- nia（VAP） in patients, who were treated with mechanical ventilation in the First Affiliated Hospital of Anhui Medical Uni- versity from September 2015 to August 2016, so as to provide the basis of the early prevention and control of ventilator asso- ciated pneumonia. Methods A retrospective analysis was conducted among the patients who were treated with mechanical ventilation in the First Affiliated Hospital of Anhui Medical University from September 1, 2015 to August 31, 2016. The pathogenic bacteria distribution and drug resistance rate were studied. Results A total of 75 l patients were treated with mechanical ventilation and 303 strains of pathogenic bacteria were isolated. Most of bacteria samples were obtained from sputum （81.85%）, blood （6. 93% ） and urine （2. 64% ）. Gram-negative bacteria, gram-positive bacteria and fungi ac- counted for 84. 61% , 6. 93% and 8.91% , respectively. According to the result of drug susceptibility tests, Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli were four main types of gram-negative bacteria, and the main type of gram-positive bacteria was Staphylococcus aureus. The risk factors of VAP included pa- tients＇ indwelling gastric tube, more than three types of antibiotics application, extension of duration of mechanical ventila- tion and ICU length of stay. Conclusions Gram-negative bacteria accounted for the largest proportion of pathogenic bacte- ria in patients treated with ventilator. For the purpose of instructing antibiotics selection in clinical practice, it is necessary to explore the rate of drug resistance and other risk factors.