Risk factors for ventilator-associated pneumonia in trauma patients:A descriptive analysis

BACKGROUND:We sought to evaluate the risk factors for developing ventilator-associated pneumonia(VAP)and whether the location of intubation posed a risk in trauma patients.METHODS:Data were retrospectively reviewed for adult trauma patients requiring intubation for>48 hours,admitted between 2010 and 2013.Patients’demographics,clinical presentations and outcomes were compared according to intubation location(prehospital intubation[PHI]vs.trauma room[TRI])and presence vs.absence of VAP.Multivariate regression analysis was performed to identify predictors of VAP.RESULTS:Of 471 intubated patients,332 patients met the inclusion criteria(124 had PHI and208 had TRI)with a mean age of 30.7±14.8 years.PHI group had lower GCS(P=0.001),respiratory rate(P=0.001),and higher frequency of head(P=0.02)and chest injuries(P=0.04).The rate of VAP in PHI group was comparable to the TRI group(P=0.60).Patients who developed VAP were 6 years older,had significantly lower GCS and higher ISS,head AIS,and higher rates of polytrauma.The overall mortality was 7.5%,and was not associated with intubation location or pneumonia rates.In the early-VAP group,gram-positive pathogens were more common,while gram-negative microorganisms were more frequently encountered in the late VAP group.Logistic regression analysis and modeling showed that the impact of the location of intubation in predicting the risk of VAP appeared only when chest injury was included in the models.CONCLUSION:In trauma,the risk of developing VAP is multifactorial.However,the location of intubation and presence of chest injury could play an important role.

Distribution and antibiotic resistance of pathogens isolated from ventilator-associated pneumonia patients in pediatric intensive care unit

BACKGROUND： With mechanical ventilation widely used in intensive care unit, the ventilator associated pneumonia （VAP） has become a common and serious complication in critically ill patients. Compared with adults, the incidence of VAP and the mortality are higher in children in pediatric intensive care unit （PICU） because of immune deficiency, severe basic diseases, and increased use of artificial airway or mechanical ventilation. Hence it is of significance to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence and mortality of VAP in children.METHODS： From January 2008 to June 2010, 2758 children were treated in PICU of Wuhan Children＇s Hospital. Among them, 171 received mechanical ventilation over 48 hours in PICU, and 46 developed VAP. The distribution and drug-resistance pattern of the pathogenic bacteria isolated from lower respiratory tract aspirations were analyzed. RESULTS：A total of 119 pathogenic microbial strains were isolated. Gram-negative bacilli （G-） were the most （65.55%）, followed by fungi （21.01%） and gram-positive cocci （G~, 13.45%）. Among them, the most common pathogens were Acinetobacter baummannii, Escherichia coli, Klebsiella pneumoniae, candida albicans and coagulase-negative staphylococci. Antibiotic susceptibility tests indicated that the multiple drug-resistances of G- and G＋to antibiotics were serious. Most of G- was sensitive to ciprofloxacin, amikacin, imipenem, meropenem, cefoperazone-sulbactam and piperacillin-tazobactam. The susceptibility of G＋ to vancomycin, teicoplanin and linezolid were 100%. Fungi were almost sensitive to all the antifungal agents. The primary pathogens of VAP were G-, and their multiple drug-resistances were serious. CONCLUSION： In clinical practice we should choose the most sensitive drug for VAP according to pathogenic test.

Effect of traditional Chinese preparation Xuebijing on inflammatory markers in patients with ventilator-associated pneumonia

Objective:To observe the effect of Xuebijing,a complex traditional Chinese preparation,on inflammation and prognosis of patients with pneumonia.Methods:The patients with ventilator-associated pneumonia in the intensive care unit(ICU)were randomly divided into the control group and the treatment group with 35 cases in each group.Both groups were given routine treatment such as anti-inflammatory drugs,rehydration,expectorant,and nutritional support,while the treatment group was additionally given Xuebijing injection.Serum C-reactive protein(CRP),clinical pulmonary infection score(CPIS),acute physiology,and chronic health scoreⅡ(APACHEⅡ)were recorded before treatment,the 3rd and 7th day after treatment.The duration of antibiotic use,mechanical ventilation,ICU stay,and mortality during 28 days was recorded.Results:There was no significant difference in CRP,CPIS,and APACHEⅡbetween the two groups before treatment(P>0.05).The improvement of CRP,CPIS,and APACHEⅡin the treatment group was better than those in the control group on the 3 and 7 days after treatment,and the differences were statistically significant(P<0.05).The duration of antibiotic use,mechanical ventilation,and ICU stay in the treatment group were less than those in the control group(P<0.05).The 28-day mortality of the treatment group was lower than that of the control group,but the difference was not statistically significant(P>0.05).Conclusions:Xuebijing injection can improve the inflammatory indexes of patients with ventilator-associated pneumonia,and can partly improve the prognosis.

Respiratory mechanics,ventilator-associated pneumonia and outcomes in intensive care unit

AIM To evaluate the predictive capability of respiratory mechanics for the development of ventilator-associated pneumonia (VAP) and mortality in the intensive care unit(ICU) of a hospital in southern Brazil. METHODS A cohort study was conducted between, involving a sample of 120 individuals. Static measurements of compliance and resistance of the respiratory system in pressure-controlled ventilation (PCV) and volumecontrolled ventilation(VCV) modes in the 1 st and 5 th days of hospitalization were performed to monitor respiratory mechanics. The severity of the patients' illness was quantified by the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ). The diagnosis of VAP was made based on clinical, radiological and laboratory parameters.RESULTS The significant associations found for the development of VAP were APACHE Ⅱ scores above the average(P = 0.016), duration of MV (P = 0.001) and ICU length of stay above the average(P = 0.003), male gender(P = 0.004), and worsening of respiratory resistance in PCV mode(P = 0.010). Age above the average(P < 0.001), low level of oxygenation on day 1(P = 0.003) and day 5 (P = 0.004) and low lung compliance during VCV on day 1 (P = 0.032) were associated with death as the outcome.CONCLUSION The worsening of airway resistance in PCV mode indicated the possibility of early diagnosis of VAP. Low lung compliance during VCV and low oxygenation index were death-related prognostic indicators.

Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria

BACKGROUND Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation(MV).The emergence of multidrug resistant bacteria(MDRB)has become a public health problem,creating a new burden on medical care in hospitals,particularly for patients admitted to the intensive care unit(ICU).AIM To describe risk factors for ventilator-acquired pneumonia(VAP)in patients with cancer and to evaluate the impact of MDRB.METHODS A retrospective study was performed from January 2016 to December 2018 at a cancer referral center in Mexico City,which included all patients who were admitted to the ICU and required MV≥48 h.They were classified as those who developed VAP versus those who did not;pathogens isolated,including MDRB.Clinical evolution at 60-d was assessed.Descriptive analysis was carried out;comparison was performed between VAP vs non-VAP and MDRB vs non-MDRB.RESULTS Two hundred sixty-three patients were included in the study;mean age was 51.9 years;52.1%were male;68.4%had solid tumors.There were 32 episodes of VAP with a rate of 12.2%;11.5 episodes/1000 ventilation-days.The most frequent bacteria isolated were the following:Klebsiella spp.[n=9,four were Extended-Spectrum Beta-Lactamase(ESBL)producers,one was Carbapenem-resistant(CR)];Escherichia coli(n=5,one was ESBL),and Pseudomonas aeruginosa(n=8,two were CR).One Methicillin-susceptible Staphylococcus aureus was identified.In multivariate analysis,the sole risk factor associated for VAP was length of ICU stay(OR=1.1;95%CI:1.03-1.17;P=0.003).Sixty-day mortality was 53%in VAP and 43%without VAP(P=0.342).There was not higher mortality in those patients with MDRB.CONCLUSION This study highlights the high percentage of Gram-negative bacteria,which allows the initiation of empiric antibiotic coverage for these pathogens.In this retrospective,single center,observational study,MDRB VAP was not directly linked to increased mortality at 60 days.

Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain:Prevalence and antibiotics susceptibility pattern

BACKGROUND Ventilator-associated pneumonia(VAP)is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that.It is the most common infection encountered among intubated patients.VAP incidence showed wide variability between countries.AIM To define the VAP incidence in the intensive care unit(ICU)in the central gove-rnment hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern.METHODS The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020.It included adult and adolescent patients(>14 years old)admitted to the ICU and required intubation and mechanical ventilation.VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score,which considers the clinical,laboratory,microbiological,and radiographic evidence.RESULTS The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155.Forty-six patients developed VAP during their ICU stay(29.7%).The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period,with a mean age of 52 years±20.Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96±6.55.Gram-negative contributed to most VAP cases in our unit,with multidrug-resistant Acinetobacter being the most identified pathogen.CONCLUSION The reported VAP rate in our ICU was relatively high compared to the international benchmark,which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.

Antimicrobial resistance pattern in ventilator-associated pneumonia in an intensive care unit of Babol, northern Iran

Objective:To investigate antibiotic resistance pattern of ventilator-assiated pneumonia (VAP) generating microorganisms,and quantitative culture and determining antibiotic sensitivity.Methods:This cross sectional study was performed on 50 patients suffering from VAP in intensive care unit of Ayatollah Rouhani Hospital,Babol,Iran during 2014-2015.VAP was probable for them based on clinical signs and the criteria of Clinical Pulmonary Infection Score standards.Lower respiratory samples were given under bronchoalveolar lavage and quantitative culture was done on them.Afterwards by microdilution method,minimal inhibitory concentration based on respective microorganisms,considering clinical pulmonary infection score were determined.Results:From 50 investigated samples in this study,the most common microorganisms were Acinetobacter baumannii (A.baumannii) (70%) then Pseudomonas aeruginosa (12%),Staphylococcus aureus (8%) and Klebsiella pneumonia (3%).In our study A.baummannii showed approximate 100% resistance to all antibiotics,in a way that A.baumannii resistance to imipenem and meropenem and piperacillin/tazobactam each was 97.1%.The most resistance of Pseudomonas aeruginosa was 66.7% to each cefepime and ceftazidime and clavulanate/ticarcillin.Staphylococcus aureus showed 75% resistance to nafcillin,cloxacillin and resistance in case of vancomycin was not seen.Conclusion:In current study,A.baumannii had the most prevalence among VAP and this species is resistant to most of antibiotics.Using ceftazidime,cefepime and clavulanate/ticarcillin,in treatment of the patients suffering VAP is not reasonable.

Natural History, Outcomes and Antibiotic Treatment for Ventilator-Associated Tracheobronchitis in Critical Ill Patients

We assessed incidence and outcomes of patients with ventilator-associated respiratory infections (VARI) due to tracheobronchitis (VAT) and pneumonia (VAP), including length of intensive care unit (ICU) stay and ventilator days. We also examined pathogens, rate of progression from VAT to VAP, and impact of antibiotic therapy for VAT. Data analysis included 234 patients, 100 patients (43%) had at least moderate (+++) bacterial growth in their semi-quantitative endotracheal aspirate (SQ-ETA) cultures. VAT and VAP were each diagnosed in 34 (15%) patients. Staphylococcus aureus was the most common pathogen isolated and had the highest rate of progression from VAT to VAP. Seven (21%) of the 34 patients were diagnosed with VAT that later progressed to VAP in averaged 3 days. Patients diagnosed with VAT had significantly more ventilator days (9 vs 6, p p < 0.001) and hospital days (22 vs 17, p < 0.001). No significant difference was observed in the clinical outcomes of the 25 VAT patients with timely, appropriate antibiotics compared to the 9 VAT patients who did not receive timely appropriate antibiotics. VAT was a risk factor for increased ventilator days, longer length of ICU and hospital stay. The time window from VAT to VAP allowed physicians to identify the pathogens and sensitivity profile needed to treat VAT with appropriate antibiotics. Data from well-designed studies were needed to assess the impact of early, appropriate antibiotic therapy for VAT, the choice of antibiotics, as well as the duration and route of administration.

拔出气管插管护理方法预防吸入性肺炎的研究

目的：探讨拔出气管插管时和拔出后不同护理方法预防吸入性肺炎的疗效。方法：将345例EICU的住院患者随机分为实验组174例和传统组171例。实验组拔管前给予双氧水和生理盐水进行口腔护理,再充分吸净口腔、咽腔、鼻腔及气道内的分泌物;吸痰管插至气管最深部后再拔出1cm,然后提拉捻转边吸引边拔管;拔管前6~8h禁食、拔管后2h禁食,且拔管前抽吸净胃内容物;如无禁忌证拔管时及拔管后持续抬高床头30°~45°;拔管后2h先协助患者更换体位,患者如无特殊不适,可给予温开水50ml入胃,饮水后1h内即不可立即更换体位,观察患者有无恶心、呕吐等反应,如无不良反应或胃潴留,1h后可给予米油100ml入胃,并逐渐增加饮食量和食物的黏稠度,同时,密切观察患者饮食后的反应。传统组采用传统拔管时和拔管后的护理方法。观察两组误吸的发生率和在EICU的住院时间。结果：实验组误吸6例（3.45%）,传统组误吸22例（12.87%）,差异有统计学意义（P〈0.01）;实验组在EICU住院时间为（8.3±6.9）d,传统组为（18.4±8.5）d,差异有统计学意义（P〈0.01）。结论：实验组的护理方法可有效的预防拔出气管导管时和拔出后误吸的发生率,从而降低吸入性肺炎的发生。

中西医结合治疗对呼吸机相关肺炎患者IL-6、IL-8及TNF-α的影响

目的观察中西医结合治疗对呼吸机相关肺炎(VAP)患者白细胞介素6(IL-6)、白细胞介素8(IL-8)及肿瘤坏死因子-α(TNF-α)水平的影响。方法 52例患者随机分为治疗组26例予中西医结合治疗与对照组26例(单予西医治疗),疗程2周;比较两组患者治疗前后IL-6、IL-8及TNF-α的水平。结果治疗组总有效率高于对照组,其IL-6、IL-8和TNF-α水平较对照组下降更为明显。结论中西医结合可明显降低VAP患者IL-6、IL-8和TNF-α水平,减轻炎症反应,提高临床疗效。

哌啦西林/他唑巴坦治疗老年院内获得性肺炎的临床疗效

【目的】观察哌啦西林/他唑巴坦在治疗老年院内获得性肺炎的临床疗效。【方法】68例老年院内获得性肺炎患者随机分为两组,每组各34例,分别给予哌啦西林/他唑巴坦与头孢他啶静脉滴注,并观察临床及细菌学指标、临床疗效及安全性。【结果】哌啦西林/他唑巴坦与头孢他啶组的治疗有效率分别为91.2%和70.6%,细菌清除率为88.1%和66.7%,两组比较差异有显著性(P<0.05);细菌敏感率分别为84.0%和79.0%,两组相比差异无显著性(P>0.05)。【结论】哌啦西林/他唑巴坦可有效治疗老年院内获得性肺炎,是一种广谱、安全的抗菌药物。

恙虫病15例误诊分析

收集本院近３ 年来恙虫病并发肺炎１５ 例，确诊前均为误诊，通过分析其临床表现、胸片等检查，阐明了误诊原因，采用以多西环素为主的综合治疗，治愈率达１００ ％ ．

桂枝挥发油对LPS致急性肺损伤大鼠模型蛋白酪氨酸激酶活性的影响

目的:探讨桂枝挥发油对LPS致大鼠急性肺损伤模型蛋白酪氨酸激酶活性的影响;方法:采用LPS 1 mg/kg尾静脉注射构建大鼠急性肺损伤模型,取肺组织,采用ELISA方法检测不同干预组肺组织中PTK含量,比较组间差异;结果:研究表明,SD大鼠正常肺组织中PTK含量为(44.21±31.51)pmol/mL;模型组含量为(173.58±97.95)pmol/mL,较空白组显著增高,具有极显著的统计学意义(P<0.001);VORC高、中、低3个剂量组PTK含量均较模型组显著降低(P<0.05),有一定的量效关系。结论:桂枝挥发油能够抑制LPS所致大鼠急性肺损伤肺组织中PTK的异常增高,对PTK活性的抑制可能是桂枝挥发油发挥抗炎作用的主要机制之一。

广西成人社区获得性肺炎889例病原学多中心调查

目的 为掌握广西地区成人社区获得性肺炎（CAP）的病原学构成情况,比较广西农村和城市CAP的病原学构成特点,推进广西地区CAP的规范化诊疗。方法 收集2008-01~2010-12广西14所县市级医院的889例CAP患者,进行病原学调查,并根据地域分为城市地区（城市组331例）和农村地区（农村组578例）,比较病原学构成比差异。结果 研究期CAP病例中阳性422例患者入选,共检出486株病原菌,前五位的病原菌为肺炎支原体（138/486,28.40%）、流感嗜血杆菌（88/486,18.11%）、肺炎链球菌（77/486,15.84%）、肺炎克雷伯杆菌（53/486,10.91%）和肺炎衣原体（43/486,8.94%）。农村组肺炎支原体、铜绿假单胞菌感染的CAP比例高于城市组（41.12%vs 19.72%和5.58%vs 1.73%）,而肺炎链球菌、嗜肺军团菌感染低于城市组（8.1%vs 21.11%和3.05%vs 7.96%）。城市组细菌（除外嗜肺军团菌）多见（183例,占63.3%）,农村组则以非典型病原体多见（104例,占52.8%）。结论 广西成人CAP病原学以肺炎支原体最常见,流感嗜血杆菌和肺炎链球菌也是常见菌群。广西农村地区以非典型病原菌为主,城市则以细菌常见。

甘油生产1,3-丙二醇发酵工艺优化研究

1,3-丙二醇是合成聚对苯二甲酸丙二醇酯的基础原料,利用甘油进行微生物发酵生产1,3-丙二醇的生物炼制技术具有广阔的应用前景。以克雷伯氏肺炎杆菌为出发菌种,对菌种保藏方式、发酵体系环境、氮气通气比、p H中和剂以及甘油品质等发酵工艺进行了优化研究。实验结果表明,在较优的工艺条件下,1,3-丙二醇产量可达103.38 g/L。

深圳市儿童支原体感染流行病学分析

目的观察深圳市儿童支原体的流行情况。方法对2004年1月至2005年12月在我院确诊为下呼吸道感染的5725例患儿取静脉血，用ELISA法检测肺炎支原体特异性抗体IgM（Mp—IgM）。结果两年间该地区下呼吸道感染患儿中，Mp—IgM的总检出率为43．1％，其中2004年10月至2005年9月，Mp—IgM的检出率持续达40％以上，感染患几经临床相应治疗均取得明显效果，证实该期间存在支原体流行；发病年龄前移，1～3岁的儿童Mp—IgM的检出率高达53．5％，≤1岁的婴儿检出率为26．7％。结论肺炎支原体已成为本地区小儿下呼吸道感染的主要病原体，本病的发生及流行应引起临床医生的高度重视。

中西医结合治疗对呼吸机相关肺炎患者T细胞亚群及NK细胞的影响

目的:观察中西医结合治疗对呼吸机相关肺炎患者T细胞亚群及NK细胞的影响。方法:52例患者随机分为中西医结合治疗组(26例)及西药对照组(26例),治疗组在常规西药治疗的同时根据患者情况辨证分为痰热壅肺和痰湿阻肺两型并辨证治疗,疗程2周,观察两组患者治疗前后T细胞亚群及NK细胞的变化。结果:中西医结合治疗组治疗后CD4升高、CD8下降、CD4/CD8升高、NK升高,与治疗前相比均有显著差异。结论:中西医结合治疗呼吸机相关肺炎通过改善患者细胞免疫功能,增强机体抗病能力,从而提高整体疗效。

基于案例梳理的基层医疗卫生机构重大传染性疾病防控:经验、问题与对策

基层医疗卫生机构作为基本公共卫生与基本医疗卫生服务的提供者,在防治重大传染性疾病中的作用日益显现,基于2003年重症急性呼吸综合征(SARS)、2009年甲型H1N1流感和2019年的新型冠状病毒肺炎基层参与防控的多案例梳理发现,基层医疗卫生机构重大传染病防控能力尚存不足。主要表现为传染病防控机制不完善、卫生资源欠缺、预防性健康教育疏漏和信息化水平不高等问题,建议通过进一步改革传染病应急防控机制,联合多元主体,吸引社会资本,优化卫生资源、人才和设备配置,落实分级诊疗和家庭医生制度,加强信息化建设和树立“平战结合”思想、促进健康教育等方式,逐步提升基层医疗卫生机构传染病防控能力。

大剂量沐舒坦治疗重型颅脑损伤气管切开后并发肺部感染临床分析

目的研究大剂量沐舒坦在重度颅脑损伤气管切开后并发肺部感染中的治疗作用。方法选择重型颅脑损伤气管切开后并发肺部感染患者48例,随机分为对照组和治疗组;治疗组予以静脉滴注沐舒坦(德国勃林格殷格翰公司生产)15 mg/(kg.d),对照组静脉滴注2 mg/(kg.d)。两组其他用药均相同。比较两组患者痰液黏稠度及胸部X线片。结果静脉滴注大剂量沐舒坦,可以使肺部痰液易于变得稀薄,痰液更易于咳出和吸出,胸部X线片显示治疗组肺部感染征象控制好于对照组(χ2=5.07,P<0.05)。结论大剂量沐舒坦有助于改善气管切开患者痰液黏稠度,促进排痰,控制肺部感染,缩短疗程。

紫外诱变选育高耐受1,3-丙二醇的克雷伯氏杆菌

1,3-丙二醇具有许多优良的化学性质,可以作为中间体合成多种有经济价值的工业用化合物,是一种潜在的重要化工平台产品。文章以产1,3-丙二醇的肺炎克雷伯氏菌为出发菌株,通过紫外诱变筛选得到耐受1,3-丙二醇130 g/L的突变株。该突变株以甘油为底物,发酵48 h,发酵液中1,3-丙二醇的质量浓度达到96.57 g/L。