ICU呼吸机相关性肺炎病原谱耐药性变迁的相关因素分析

Factors related to the changes in drug resistance of pathogen spectrum of ventilator-associated pneumonia in ICU

目的分析ICU呼吸机相关性肺炎(VAP)病原谱耐药性变迁的相关因素。方法回顾性分析2019年1月至2021年12月宜春市人民医院ICU收治的1164例患者的临床资料,分析VAP发生率、病原菌分布情况及耐药性变迁情况,采用单因素及多因素Logistic回归分析发生VAP的影响因素。结果1164例患者中,共发生VAP82例,2019至2021年VAP发生率分别为9.35%、7.28%、5.13%,呈逐年下降趋势。82例VAP患者中,共培养出病原菌129株,多重耐药(MDR)病原菌共103株(79.84%),包括革兰阴性杆菌(72.87%)和革兰阳性球菌(27.13%);2019至2020年与2020至2021年病原菌分布比较,革兰阴性杆菌由55.56%增加至79.57%,而革兰氏阳性球菌由44.44%下降至20.43%。2019至2021年AB对左氧氟沙星、阿米卡星的耐药率升高;2019至2021年Kpn对阿米卡星、环丙沙星耐药率下降;2019至2021年PAE对亚胺培南、环丙沙星的耐药率下降。发生VAP患者男性、机械通气时间>8d、联合用药、中心静脉置管患者比例均高于未发生VAP患者,入住ICU时间>14d、比例低于未发生VAP患者,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,机械通气时间>8d、联合用药是VAP发生的独立影响因素(P<0.05)。结论临床需重视VAP耐药性变迁现象,对机械通气时间>8d、联合用药的ICU患者应高度警惕VAP风险。

Objective To analyze the factors related to the changes in drug resistance of pathogen spectrum of ventilator-associated pneumonia(VAP)in ICU.Methods The clinical data of 1164 patients admitted to ICU of Yichun People's Hospital from January 2019 to December 2021 were retrospectively analyzed,the incidence of VAP,the distribution of pathogenic bacteria and the changes of drug resistance were analyzed,the influenc-ing factors of VAP were analyzed by univariate and multivariate Logistic regression.Results Among the 1164 patients,82 cases of VAP occurred,and the incidence of VAP in 2019 to 2021 was 9.35%,7.28%and 5.13%,respectively,showing a decreasing trend year by year.Among 82 VAP pa-tients,129 strains of pathogens were cultured,103 strains(79.84%)of multi-drug resistant(MDR)pathogens,including Gram-negative bacteria(72.87%)and Gram-positive bacteria(27.13%);compared with the distribution of pathogens from 2020 to 2021,Gram-negative bacilli increased from 55.56%to 79.57%,while Gram-positive cocci decreased from 44.44%to 20.43%.The drug resistance rate of AB to levofloxacin and amikacin increased from 2019 to 2021;the drug resistance rate of Kpn to amikacin and ciprofloxacin decreased from 2019 to 2021;the drug resistance rate of PAE to imipenem and ciprofloxacin decreased from 2019 to 2021.The proportion of male,mechanical ventilation time>8 d,combined medication,and central venous catheterization of patients with VAP was higher than that without VAP,the proportion of ICU stay time>14 d of patients with VAP was lower than that without VAP,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that mechanical ventilation time>8 d and combined medication were independent factors for the occurrence of VAP(P<0.05).Conclusion Clini-cal attention should be paid to the changes in drug resistance of VAP,and the risk of VAP in ICU patients with mechanical ventilation time>8 d and combination therapy should be highly vigilant.