白假丝酵母合并鲍曼不动杆菌所致的VAP患者临床特点、耐药性及预后分析

Clinical Characteristics,Drug Resistance and Prognosis of VAP Caused by Candida Albicans Combined with Acinetobacter Baumannii

【目的】探讨白假丝酵母合并鲍曼不动杆菌所致的呼吸机相关性肺炎(VAP)患者临床特点、耐药性及预后情况。【方法】选取2018年3月至2021年7月在宝鸡高新医院和兵器工业五二一医院诊治的128例白假丝酵母合并鲍曼不动杆菌所致的VAP患者,分析所有VAP患者临床特点、耐药性,随访4周,统计患者预后情况,分析白假丝酵母合并鲍曼不动杆菌所致的VAP患者预后影响因素。【结果】128例白假丝酵母合并鲍曼不动杆菌致VAP患者临床特征多表现为咳嗽、咳痰、呼吸困难、发热,肺部多见水泡音。白假丝酵母菌株对霉菌素、克霉唑较为敏感,耐药率分别为0、6.25%,对其余抗菌药物耐药率均>10%;鲍曼不动杆菌株对替加环素、米诺环素较为敏感,耐药率分别为0、23.44%,对其余抗菌药物耐药率均>30%。Logistic多因素回归分析显示:白蛋白、急性生理与慢性健康评分(APACHEⅡ)、临床肺部感染评分(CPIS)、第二次气管插管、抗生素使用时间均是假丝酵母合并鲍曼不动杆菌所致的VAP患者预后影响因素(P<0.05)。【结论】白假丝酵母合并鲍曼不动杆菌所致的VAP患者临床特征多样,对多种常用抗生素具有高耐药性,临床治疗白假丝酵母合并鲍曼不动杆菌所致的VAP可首选霉菌素、克霉唑、替加环素、米诺环素,白蛋白、APACHEⅡ、CPIS、第二次气管插管、抗生素使用时间均是白假丝酵母合并鲍曼不动杆菌所致的VAP患者预后的影响因素。

【Objective】To investigate the clinical characteristics,drug resistance and prognosis of ventilator-associated pneumonia(VAP)caused by Candida albicans combined with Acinetobacter baumannii.【Methods】A total of 128 patients with VAP caused by Candida albicans combined with Acinetobacter baumannii who were admitted to our hospitals from March 2018 to July 2021 were selected as the research objects.The clinical characteristics and drug resistance of the patients were analyzed.After 4 weeks of follow-up,the factors for patient prognosis were analyzed as well.【Results】The clinical features of 128 patients with VAP caused by Candida albicans combined with Acinetobacter baumannii were mostly cough,expectoration,dyspnea,fever,and blisters in the lungs.Candida albicans strains are more sensitive to mycotoxins and clotrimazole,whose resistance rates were 0 and 6.25%,respectively.However,the resistance rates to other antibiotics were all>10%.Acinetobacter baumannii strains were sensitive to tigecycline and minocycline,with resistance rates of 0 and 23.44%,respectively.And its resistance rates to other antibiotics were all>30%.Logistic multivariate regression analysis showed that albumin,acute physiology and chronic health evaluation scoreⅡ(APACHEⅡ),clinical pulmonary infection score(CPIS),secondary tracheal intubation,antibiotic use time were factors that affected the prognosis of VAP patients caused by candida combined with acinetobacter baumannii(P<0.05).【Conclusion】The clinical characteristics of patients with VAP caused by candida albicans combined with acinetobacter baumannii are diverse,and they are highly resistant to a variety of commonly used antibiotics.The first choices for clinical treatment of VAP caused by candida albicans combined with acinetobacter baumannii were mycotoxins,clotrimazole,tigecycline and minocycline.Albumin,APACHEⅡscore,CPIS score,secondary tracheal intubation,antibiotic use time are the factors that affect the prognosis of patients with VAP caused by Candida and Acinetobacter baumannii.