某院高龄患者呼吸机相关性肺炎感染现况及危险因素分析

Analysis of current status and risk factors of ventilator-associated pneumonia in elderly patients in a hospital

目的分析高龄患者呼吸机相关性肺炎(VAP)感染特点及其危险因素。方法回顾性收集某医院2016年1月—2019年9月行机械通气的高龄患者临床基线资料,统计发生VAP患者的病原菌种类,Logistic多因素回归分析感染的影响因素。结果在292例行机械通气的高龄患者中,发生VAP 43例,感染率为14.73%。VAP患者分离病原菌60株,其中革兰阴性菌占83.33%,主要以鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌为主,分别占26.67%、11.67%和11.67%;革兰阳性菌和真菌占比均为8.33%。药敏结果提示,耐碳青霉烯类鲍曼不动杆菌、耐碳青霉烯类肺炎克雷伯菌检出率分别为62.50%和20.00%。Logistic多因素回归分析显示,性别、呼吸机使用天数、合并糖尿病、抗菌药物种类、APACHE-Ⅱ评分是高龄患者发生VAP的独立危险因素。结论高龄患者VAP发生率较高,分离病原菌以革兰阴性菌为主,耐药菌株检出率高,临床医生应根据患者病情早期干预其呼吸机使用天数、抗菌药物种类等感染高危因素,降低患者VAP发生风险。

Objective To analyze the infective characteristics and risk factors of ventilator-associated pneumonia( VAP)in elderly patients. Methods The clinical baseline data of elderly patients undergoing mechanical ventilation from January2016 to September 2019 in a hospital were retrospectively collected. The types of pathogenic bacteria in patients with VAP were counted,and the influencing factors of infection were analyzed by Logistic multivariate regression analysis. Results Among 292 elderly patients who were mechanically ventilated,43 cases of VAP occurred,and the infection rate was14. 73%. 60 strains of pathogenic bacteria were isolated from VAP patients,of which Gram-negative bacteria accounted for 83. 33% and were mainly Acinetobacter baumannii,Klebsiella pneumoniae and Pseudomonas aeruginosa,accounting for26. 67%,11. 67% and 11. 67%,respectively. Both Gram-positive bacteria and fungi accounted for 8. 33%. The drug sensitivity results indicated that the detection rates of carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Klebsiella pneumoniae were 62. 50% and 20. 00% respectively. Logistic multivariate regression analysis showed that gender,ventilator use days,combined diabetes,types of antibacterial drugs,and APACHE-Ⅱ score were independent risk factors for VAP in elderly patients. Conclusion The incidence of VAP in elderly patients was relatively high. The main pathogens isolated were Gram-negative bacteria,and the detection rate of drug-resistant strains was high. Clinicians should intervene early in high-risk factors of infection such as ventilator use days and types of antibacterial drugs to reduce the risk of VAP in patients.