潜在耐药菌引发呼吸机相关肺部感染的调查

Ventilator-associated Pneumonia Caused by Potentially Drug-resistant Bacteria: Investigation and Analysis

目的 确定潜在耐药菌所致呼吸机相关肺部感染 (VAP)的发病率及危险因素。方法 对机械通气时间>4 8h的 171例患者做前瞻性调查 ,分别用单因素及多因素检验判定耐药菌及其他致病菌引发VAP的危险因素。结果 VAP在持续机械通气患者中的发病率较高 (5 5 .5 5 % ) ,并大多由潜在耐药菌引发 (6 9.4 7% ) ;耐药菌已占分离菌株总数的 5 3.36 % ,并对多种常用抗菌药物严重耐药 ;此外 ,机械通气时间延长及先期有广谱抗菌药物应用史显著相关于耐药菌引发的VAP。结论 在监护病室耐药菌引发的VAP已日趋严重 ,应重视并强调对抗菌药物的合理应用。

OBJECTIVE To determine the incidence and risk factors of ventilator associated pneumonia caused by potentially drug resistant bacteria. METHODS A total of 171 patients mechanically ventilated for more than 48 hours were selected for the prospective study. The potential risk factors associated with VAP caused by potentially drug resistant bacteria or other causative organisms were selected by univariate analysis and Logistic regression analysis. RESULTS The incidence of VAP in patients receiving continuous ventilations is high (55.55%) and most of them were caused by potentially drug resistant bacteria (69.47%), which show multi resistance and become predominant pathogens (53.36%) of the total 446 specimens. In univariate analysis and Logistic regression analysis, main risk factors for VAP caused by potentially drug resistant bacteria are significantly associated with the duration of mechanical ventilation (MV>7 d), prior use of broad spectrum antibiotic, especially prior use of the third generation cephalosporin. CONCLUSIONS VAP caused by potentially drug resistant bacteria becomes more and more serious, to which should be paid more attention and more reasonable strategy of antibiotic use must be instituted.