感染性休克患者发生呼吸机相关性肺炎病原菌与影响因素分析
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摘要
目的探究感染性休克患者发生呼吸机相关性肺炎的病原菌特点及影响因素分析。方法回顾性分析2014年1月-2017年12月医院收治的感染性休克并接受呼吸机治疗超过48h的患者120例的临床资料。分析发生呼吸机相关性肺炎(VAP)患者的病原菌及耐药性;分析患者年龄、机械通气时间、使用抗菌药物情况等临床资料,归纳感染性休克患者发生VAP的影响因素。结果 120例患者共有48例发生VAP,发生率为40.00%;共培养分离病原菌64株,其中革兰阴性菌40株占62.50%,以鲍氏不动杆菌和铜绿假单胞菌为主;革兰阳性菌14株占21.88%,以金黄色葡萄球菌为主;真菌10株占15.63%;年龄、机械通气时间、急性生理与慢性健康(APACHEⅡ)评分、使用抗菌药物种类是感染性休克患者发生VAP的影响因素(P<0.05)。结论感染性休克患者发生VAP的病原菌耐药形势严峻,应当引起重视;应针对感染性休克患者发生VAP的影响因素,采取相应措施以降低VAP的发生率。
OBJECTIVE To explore the pathogens and risk factors of ventilator-associated pneumonia(VAP)in septic shock patients.METHODS The clinical data of 120 septic shock patients admitted to the hospital from Jan.2014-Dec.2017 who received more than 48 hof ventilator therapy were retrospectively analyzed.The pathogens and drug resistance of VAP patients were analyzed,as well as the clinical data such as the age,mechanical ventilation time and use of antimicrobial agents,and the risk factors of VAP in septic shock patients were summarized.RESULTS Among the 120 patients,there were 48 cases of VAP,with an incidence of 40.00%.A total of 64 strains of pathogens were isolated,among which 40 strains were gram-negative bacteria(62.50%),mainly Acinetobacter baumannii and Pseudomonas aeruginosa,14 strains were gram-positive bacteria(21.88%),dominated by Staphylococcus aureus,and 10 strains were fungi(15.63%).Age,mechanical ventilation time,APACHE II score of and use of antimicrobial agents were the risk factors of VAP in septic shock patients(P <0.05).CONCLUSIONIn patients with septic shock,the drug resistance of VAP pathogens is severe.Attention should be paid to the risk factors of VAP in patients with septic shock,and corresponding measures should be taken to reduce the incidence of VAP.
OBJECTIVE To explore the pathogens and risk factors of ventilator-associated pneumonia(VAP)in septic shock patients.METHODS The clinical data of 120 septic shock patients admitted to the hospital from Jan.2014-Dec.2017 who received more than 48 hof ventilator therapy were retrospectively analyzed.The pathogens and drug resistance of VAP patients were analyzed,as well as the clinical data such as the age,mechanical ventilation time and use of antimicrobial agents,and the risk factors of VAP in septic shock patients were summarized.RESULTS Among the 120 patients,there were 48 cases of VAP,with an incidence of 40.00%.A total of 64 strains of pathogens were isolated,among which 40 strains were gram-negative bacteria(62.50%),mainly Acinetobacter baumannii and Pseudomonas aeruginosa,14 strains were gram-positive bacteria(21.88%),dominated by Staphylococcus aureus,and 10 strains were fungi(15.63%).Age,mechanical ventilation time,APACHE II score of and use of antimicrobial agents were the risk factors of VAP in septic shock patients(P <0.05).CONCLUSIONIn patients with septic shock,the drug resistance of VAP pathogens is severe.Attention should be paid to the risk factors of VAP in patients with septic shock,and corresponding measures should be taken to reduce the incidence of VAP.
引文
[1]罗林城,段永建,游曼清,等.老年患者呼吸机相关性肺炎危险因素分析及病原菌研究[J].四川医学,2017,38(5):564-567.
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[12]郝恒瑞,成芳,康丽娜.呼吸机相关肺炎患儿病原菌分布、危险因素及预后分析[J].中国临床医生杂志,2016,44(9):92-94.
[13]任占凤,班玛措,李静,等.重症监护室呼吸机相关肺炎患者的病原菌特征与耐药性及相关因素分析[J].中华医院感染学杂志,2017,27(23):5325-5328.
[14] Lee H,Park JY,Lee T,et al.Intermediate risk of multidrug-resistant organisms in patients who admitted intensive care unit with healthcare-associated pneumonia[J].Korean J Intern Med,2016,31(3):525-534.
[15] Blot S,Koulenti D,Dimopoulos G,et al.Prevalence,risk factors,and mortality for ventilator-associated pneumonia in middle-aged,old,and very old critically ill patients[J].Crit Care Med,2014,42(3):601-609.
[16]谢映红.老年患者呼吸机相关性肺炎的危险因素及病原菌分析[J].实用临床医药杂志,2014,18(16):159.
[17] Rautanen A,Mills TC,Gordon AC,et al.Genome-wide association study of survival from sepsis due to pneumonia:an observational cohort study[J].Lancet Respir Med,2015,3(1):53-60.
[18]吕雪.老年呼吸机相关性肺炎病原菌分布及危险因素分析[J].山西医药杂志,2015,44(21):2482-2484.
[19] Inchai J,Pothirat C,Liwsrisakun C,et al.Ventilator-associated pneumonia:epidemiology and prognostic factors of 30-day mortality[J].Jpn J Infect Dis,2015,68(3):181-186.
[20] Balasubramanian P,Tullu MS.Erratum to:study of ventilator-associated pneumonia in a pediatric intensive care unit[J].Indian J Pediatr,2015,82(5):492.
[2] Heredia-Rodriguez M,Pelaez MT,Fierro I,et al.Impact of ventilator-associated pneumonia on mortality and epidemiological features of patients with secondary peritonitis[J].Ann Intensive Care,2016,6(1):34.
[3]支琳琳,冯伟,郭轶男,等.感染性休克患者不同时期液体负荷对机体影响的前瞻性临床研究[J].中华危重病急救医学,2015,27(1):13-16.
[4] Inchai J,Pothirat C,Liwsrisakun C,et al.Ventilator-associated pneumonia:epidemiology and prognostic indicators of30-day mortality[J].Jpn J Infect Dis,2015,68(3):181-186.
[5]杨华军,刘代顺,何仕琼.呼吸机相关性肺炎耐药菌分析及临床策略[J].临床肺科杂志,2017,22(10):1747-1750.
[6] He H,Zheng Y,Sun B,et al.Tigecycline combination for ventilator-associated pneumonia caused by extensive drugresistant Acinetobacter baumannii[J].J Thorac Dis,2016,8(10):2784-2792.
[7]陈雪霞,李小金,刘建明,等.呼吸机相关肺炎患者病原学特点及影响因素分析[J].中华医院感染学杂志,2017,27(21):4861-4864.
[8] Amaro R,Sellares J,Polverino E,et al.Antibiotic therapy prior to hospital admission is associated with reduced septic shock and need for mechanical ventilation in patients with community-acquired pneumonia[J].J Infect,2017,74(5):442-449.
[9]王欣然.防控呼吸机相关性肺炎护理建议草案VAP的概念及诊断标准[C].中华护理学会全国重症监护护理学术交流暨专题讲座会议,2009:485-486.
[10]中国医师协会急诊医师分会.中国急诊感染性休克临床实践指南[J].中华急诊医学杂志,2016,36(3):193-206.
[11]孙长贵,成军.NCCLS抗菌药物敏感性试验执行标准第14版信息增刊更新内容介绍[C].浙江省检验医学学术会议,2004:384-387.
[12]郝恒瑞,成芳,康丽娜.呼吸机相关肺炎患儿病原菌分布、危险因素及预后分析[J].中国临床医生杂志,2016,44(9):92-94.
[13]任占凤,班玛措,李静,等.重症监护室呼吸机相关肺炎患者的病原菌特征与耐药性及相关因素分析[J].中华医院感染学杂志,2017,27(23):5325-5328.
[14] Lee H,Park JY,Lee T,et al.Intermediate risk of multidrug-resistant organisms in patients who admitted intensive care unit with healthcare-associated pneumonia[J].Korean J Intern Med,2016,31(3):525-534.
[15] Blot S,Koulenti D,Dimopoulos G,et al.Prevalence,risk factors,and mortality for ventilator-associated pneumonia in middle-aged,old,and very old critically ill patients[J].Crit Care Med,2014,42(3):601-609.
[16]谢映红.老年患者呼吸机相关性肺炎的危险因素及病原菌分析[J].实用临床医药杂志,2014,18(16):159.
[17] Rautanen A,Mills TC,Gordon AC,et al.Genome-wide association study of survival from sepsis due to pneumonia:an observational cohort study[J].Lancet Respir Med,2015,3(1):53-60.
[18]吕雪.老年呼吸机相关性肺炎病原菌分布及危险因素分析[J].山西医药杂志,2015,44(21):2482-2484.
[19] Inchai J,Pothirat C,Liwsrisakun C,et al.Ventilator-associated pneumonia:epidemiology and prognostic factors of 30-day mortality[J].Jpn J Infect Dis,2015,68(3):181-186.
[20] Balasubramanian P,Tullu MS.Erratum to:study of ventilator-associated pneumonia in a pediatric intensive care unit[J].Indian J Pediatr,2015,82(5):492.