呼吸机相关性肺炎病原菌与炎症反应监测的价值
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摘要
目的探讨呼吸机相关性肺炎病原菌的分布情况及血清学炎症反应指标检测在临床中的应用价值。方法选择2017年1-12月于医院进行呼吸机治疗的患者130例为研究对象,其中存在呼吸机相关性肺炎患者80例设为试验组,无明确感染或潜伏期患者50例为疾病对照组,另外收集同期年龄、疾病谱相仿的健康体检者50例作为健康对照组。分析病原菌情况,并分别检测所有研究对象血清学炎性指标[降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、IL-10、肿瘤坏死因子-α(TNF-α)],以确定其在呼吸机相关性肺炎中的价值。结果80例呼吸机相关性肺炎患者,其中79例培养出细菌,阳性率为98.75%(79/80),共培养分离病原体104株,其中革兰阴性菌73株占70.19%,革兰阳性菌29株占27.88%,真菌1株占0.96%,其他1例占0.96%;试验组患者血清PCT、CRP分别为(0.73±0.21)μg/L、(0.84±0.34)mg/L高于疾病对照组和健康对照组(P<0.05),疾病对照组高于健康对照组(P<0.05);试验组患者血清IL-6、IL-10、TNF-α分别为(0.53±0.14)pg/ml、(0.59±0.15)pg/ml、(0.57±0.13)pg/ml高于疾病对照组及健康对照组(P<0.05),疾病对照组高于健康对照组(P<0.05)。结论呼吸机相关性肺炎患者病原菌以革兰阴性菌为主,临床早期经验性治疗应首选革兰阴性菌较敏感的抗菌药物;血清CRP、PCT及炎性因子的检测对呼吸机相关性肺炎的诊断具有重要的指导作用。
OBJECTIVE To investigate the distribution of pathogens isolated from patients with ventilator-associated pneumonia(VAP)and analyze the clinical value of inflammatory response indexes.METHODS 130 cases of patients who were treated with ventilator in the hospital from Jan 2017 to Dec 2017 were selected.Among them,80 cases with ventilator-associated pneumonia were included in the experimental group,and 50 cases without definite infection or in latent period were included in the disease control group.In addition,50 healthy persons with similar age and disease spectrum were collected as the control group.The distribution of pathogens was detected in the patients in the experimental group,the serum levels of serological inflammatory markers(calcitonin,C-reactive protein,interleukin 6,interleukin 10 and TNF-α)were detected to determine their clinical value in ventilator-associated pneumonia.RESULTS Among 80 patients with ventilator-associated pneumonia,79 cases were cultured with bacteria,and the positive rate was 98.75%(79/80).104 strains of pathogens were isolated,of which 73 strains(70.19%)were gram-negative bacteria,29 strains(27.88%)were gram-positive bacteria,1 strain(0.96%)was fungus and 1 strain(0.96%)of other pathogen.The levels of serum PCT and CRP in the experimental group were(0.73±0.21)μg/L,(0.84±0.34)mg/L,significantly higher than those in the disease control group and the healthy control group(P<0.05),and those in the disease control group were significantly higher than those in the healthy control group(P<0.05).The levels of serum IL-6,IL-10 and TNF-αin the experimental group were(0.53±0.14)pg/ml,(0.59±0.15)pg/ml,(0.57±0.13)pg/ml,significantly higher than those of the disease control group and the healthy control group(P<0.05),and those of the disease control group were significantly higher than those of the healthy control group(P<0.05).CONCLUSION The pathogens of ventilator-associated pneumonia are mainly Gram-negative bacteria.Gram-negative bacteria sensitive antibiotics should be the first choice for early clinical empirical treatment.The detection of serum C reactive protein,calcitonin and inflammatory factors plays an important role in the diagnosis of ventilator-associated pneumonia.
OBJECTIVE To investigate the distribution of pathogens isolated from patients with ventilator-associated pneumonia(VAP)and analyze the clinical value of inflammatory response indexes.METHODS 130 cases of patients who were treated with ventilator in the hospital from Jan 2017 to Dec 2017 were selected.Among them,80 cases with ventilator-associated pneumonia were included in the experimental group,and 50 cases without definite infection or in latent period were included in the disease control group.In addition,50 healthy persons with similar age and disease spectrum were collected as the control group.The distribution of pathogens was detected in the patients in the experimental group,the serum levels of serological inflammatory markers(calcitonin,C-reactive protein,interleukin 6,interleukin 10 and TNF-α)were detected to determine their clinical value in ventilator-associated pneumonia.RESULTS Among 80 patients with ventilator-associated pneumonia,79 cases were cultured with bacteria,and the positive rate was 98.75%(79/80).104 strains of pathogens were isolated,of which 73 strains(70.19%)were gram-negative bacteria,29 strains(27.88%)were gram-positive bacteria,1 strain(0.96%)was fungus and 1 strain(0.96%)of other pathogen.The levels of serum PCT and CRP in the experimental group were(0.73±0.21)μg/L,(0.84±0.34)mg/L,significantly higher than those in the disease control group and the healthy control group(P<0.05),and those in the disease control group were significantly higher than those in the healthy control group(P<0.05).The levels of serum IL-6,IL-10 and TNF-αin the experimental group were(0.53±0.14)pg/ml,(0.59±0.15)pg/ml,(0.57±0.13)pg/ml,significantly higher than those of the disease control group and the healthy control group(P<0.05),and those of the disease control group were significantly higher than those of the healthy control group(P<0.05).CONCLUSION The pathogens of ventilator-associated pneumonia are mainly Gram-negative bacteria.Gram-negative bacteria sensitive antibiotics should be the first choice for early clinical empirical treatment.The detection of serum C reactive protein,calcitonin and inflammatory factors plays an important role in the diagnosis of ventilator-associated pneumonia.
引文
[1] Awad LS,Abdallah DI,Mugharbil AM,et al.An antibiotic stewardship exercise in the ICU:building a treatment algorithm for the management of ventilator-associated pneumonia based on local epidemiology and the 2016Infectious Diseases Society of America/American Thoracic Society guidelines[J].Infect Drug Resist,2017,11:17-28.
[2]孙德俊,刘卫平,闫志刚,等.呼吸机相关性肺炎病原菌分布与抗菌药物敏感性分析[J].中华医院感染学杂志,2016,26(18):4135-4137.
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[6]中华医学会呼吸病学分会.呼吸机相关性肺炎诊断、预防和治疗指南(2013)发布[J].中华医学信息导报,2013,28(11):9.
[7] Mounier R,Lobo D,Voulgaropoulos J,et al.The multistep road to ventilator-associated lung abscess:a retrospective study of Saureus ventilator-associated pneumonia[J].PLoS ONE,2017,12(12):e0189249.
[8] Torres A,Zhong N,Pachl J,et al.Ceftazidime-avibactam versus meropenem in nosocomial pneumonia,including ventilator-associated pneumonia(REPROVE):a randomised,double-blind,phase 3non-inferiority trial[J].Lancet Infect Dis,2018,18(3):285-295.
[9] Bougle A,Bombled C,Margetis D,et al.Ventilator-associated pneumonia in patients assisted by veno-arterial extracorporeal membrane oxygenation support:epidemiology and risk factors of treatment failure[J].PLoS ONE,2018,13(4):e0194976.
[10]苏家琼,杨平,鄢陵,等.呼吸机相关肺炎患者感染病原菌分布及炎症反应指标的临床评价[J].中华医院感染杂志,2017,27(22):5086-5089.
[11] Veitz-Keenan A,Ferraiolo DM.Oral care with chlorhexidine seems effective for reducing the incidence of ventilator-associated pneumonia[J].Evid Based Dent,2017,18(4):113-114.
[12] Khurana S,Mathur P,Kumar S,et al.Incidence of ventilator-associated pneumonia and impact of multidrug-resistant infections on patient's outcome:experience at an Apex Trauma Centre in North India[J].Indian J Med Microbiol,2017,35(4):504-510.
[13] Yoon BH,Romero R,Park JS,et al.The relationship among inflam-matory lesions of the umbilical cord,umbilical cord plasma IL-6concentration,amniotic fluid infection,and neonatal sepsis[J].Am J Obstet Gynecol,2000,183(5):1124-1129.
[14] Lagier D,Platon L,Lambert J,et al.Protective effect of early low-dose hydrocortisone on ventilator-associated pneumonia in the cancer patients:apropensity score analysis[J]Ann Intensive Care,2017,7(1):106.
[15] Ahmad S,Bacha N,Bakht J,et al.Characterization of pathogens involved in ventilator associated pneumonia in surgical and medical intensive care units-a single center experience[J].Pak J Pharm Sci,2017,30(6):2091-2099.
[2]孙德俊,刘卫平,闫志刚,等.呼吸机相关性肺炎病原菌分布与抗菌药物敏感性分析[J].中华医院感染学杂志,2016,26(18):4135-4137.
[3] Jaffal K,Six S,Zerimech F,et al.Relationship between hyperoxemia and ventilator-associated pneumonia[J].Ann Transl Med,2017,5(22):453.
[4] Dat VQ,Geskus RB,Wolbers M,et al.Continuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator-associated respiratory infections in Vietnam:study protocol for a randomised controlled trial[J].Trials,2018,19(1):217.
[5] Millot G,Voisin B,Loiez C,et al.The next generation of rapid point-of-care testing identification tools for ventilatorassociated pneumonia[J].Ann Transl Med,2017,5(22):451.
[6]中华医学会呼吸病学分会.呼吸机相关性肺炎诊断、预防和治疗指南(2013)发布[J].中华医学信息导报,2013,28(11):9.
[7] Mounier R,Lobo D,Voulgaropoulos J,et al.The multistep road to ventilator-associated lung abscess:a retrospective study of Saureus ventilator-associated pneumonia[J].PLoS ONE,2017,12(12):e0189249.
[8] Torres A,Zhong N,Pachl J,et al.Ceftazidime-avibactam versus meropenem in nosocomial pneumonia,including ventilator-associated pneumonia(REPROVE):a randomised,double-blind,phase 3non-inferiority trial[J].Lancet Infect Dis,2018,18(3):285-295.
[9] Bougle A,Bombled C,Margetis D,et al.Ventilator-associated pneumonia in patients assisted by veno-arterial extracorporeal membrane oxygenation support:epidemiology and risk factors of treatment failure[J].PLoS ONE,2018,13(4):e0194976.
[10]苏家琼,杨平,鄢陵,等.呼吸机相关肺炎患者感染病原菌分布及炎症反应指标的临床评价[J].中华医院感染杂志,2017,27(22):5086-5089.
[11] Veitz-Keenan A,Ferraiolo DM.Oral care with chlorhexidine seems effective for reducing the incidence of ventilator-associated pneumonia[J].Evid Based Dent,2017,18(4):113-114.
[12] Khurana S,Mathur P,Kumar S,et al.Incidence of ventilator-associated pneumonia and impact of multidrug-resistant infections on patient's outcome:experience at an Apex Trauma Centre in North India[J].Indian J Med Microbiol,2017,35(4):504-510.
[13] Yoon BH,Romero R,Park JS,et al.The relationship among inflam-matory lesions of the umbilical cord,umbilical cord plasma IL-6concentration,amniotic fluid infection,and neonatal sepsis[J].Am J Obstet Gynecol,2000,183(5):1124-1129.
[14] Lagier D,Platon L,Lambert J,et al.Protective effect of early low-dose hydrocortisone on ventilator-associated pneumonia in the cancer patients:apropensity score analysis[J]Ann Intensive Care,2017,7(1):106.
[15] Ahmad S,Bacha N,Bakht J,et al.Characterization of pathogens involved in ventilator associated pneumonia in surgical and medical intensive care units-a single center experience[J].Pak J Pharm Sci,2017,30(6):2091-2099.