机械通气患者发生VAP病原菌与影响因素分析
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摘要
目的探讨呼吸机相关性肺炎(VAP)患者感染病原菌与影响因素及干预措施。方法选取医院2016年1月-2017年12月进行机械通气治疗的患者102例为研究对象,观察VAP的病原菌情况。对VAP患者性别、年龄、意识障碍等临床资料进行分析,归纳机械通气患者发生VAP的影响因素。结果机械通气患者VAP发生率为39.22%(40/102);痰液中共培养分离病原菌68株,其中革兰阴性菌56株占82.35%,革兰阳性菌2株占2.94%,真菌10株占14.71%。药敏分析结果显示,主要病原菌对于氨苄西林、哌拉西林、头孢他啶的耐药性严重,对于氨曲南、头孢唑林较敏感。年龄,意识障碍,机械通气时间和人工气道建立方式是机械通气患者发生VAP的影响因素(P<0.05)。结论机械通气患者VAP发生率较高,应根据病原菌培养和药物耐药性分析结果合理选用抗菌药物,并采取相关的干预措施。
OBJECTIVE To investigate the pathogens,influencing factors and intervention measures of patients with ventilator-associated pneumonia(VAP).METHODS 102 patients with mechanical ventilation treatment in the hospital from Jan.2016 to Dec.2017 were selected as the subjects,and the pathogens of ventilator-associated pneumonia were observed.The clinical data of gender,age and consciousness disorder of VAP patients were analyzed,and the influencing factors of VAP in mechanical ventilation patients were summarized.RESULTS The incidence of VAP in mechanical ventilation patients was 39.22%(40/102).68 strains of pathogens were isolated and cultured in sputum,of which 56 strains of gram-negative bacteria accounted for 82.35%,2 strains of gram-positive bacteria accounted for 2.94%,and 10 strains of fungi accounted for 14.71%.The drug resistance analysis showed that the main pathogens were highly resistant to ampicillin,piperacillin and ceftazidime,and sensitive to aztreonam and cefazolin resistance.Age,disturbance of consciousness,mechanical ventilation time and artificial airway establishment were the influencing factors of VAP in mechanical ventilation patients(P<0.05).CONCLUSION The incidence of VAP in patients with mechanical ventilation is high.Antibiotics should be rationally selected according to the results of pathogen culture and drug resistance analysis,and relevant intervention measures should be taken.
OBJECTIVE To investigate the pathogens,influencing factors and intervention measures of patients with ventilator-associated pneumonia(VAP).METHODS 102 patients with mechanical ventilation treatment in the hospital from Jan.2016 to Dec.2017 were selected as the subjects,and the pathogens of ventilator-associated pneumonia were observed.The clinical data of gender,age and consciousness disorder of VAP patients were analyzed,and the influencing factors of VAP in mechanical ventilation patients were summarized.RESULTS The incidence of VAP in mechanical ventilation patients was 39.22%(40/102).68 strains of pathogens were isolated and cultured in sputum,of which 56 strains of gram-negative bacteria accounted for 82.35%,2 strains of gram-positive bacteria accounted for 2.94%,and 10 strains of fungi accounted for 14.71%.The drug resistance analysis showed that the main pathogens were highly resistant to ampicillin,piperacillin and ceftazidime,and sensitive to aztreonam and cefazolin resistance.Age,disturbance of consciousness,mechanical ventilation time and artificial airway establishment were the influencing factors of VAP in mechanical ventilation patients(P<0.05).CONCLUSION The incidence of VAP in patients with mechanical ventilation is high.Antibiotics should be rationally selected according to the results of pathogen culture and drug resistance analysis,and relevant intervention measures should be taken.
引文
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[11]王兆霞,张起,侯慧峰,等.呼吸机相关肺炎相关因素分析及综合干预措施的预防效果[J].中华医院感染学杂志,2018,28(19):2924-2927.
[12] Park SA,Cho SS,Kwak GJ.Factors influencing ventilatorassociated pneumonia in cancer patients[J].Asian Pac J Cancer Prev,2014,15(14):5787-5791.
[13] Alpkvist H,Athlin S,Molling P,et al.High HMGB1levels in sputum are related to pneumococcal bacteraemia but not to disease severity in community-acquired pneumonia[J].Sci Rep,2018,8(1):13428.
[14]李淑媛,盖鑫,张建,等.ICU机械通气患者呼吸机相关性肺炎危险因素与干预措施[J].中华医院感染学杂志,2016,26(1):76-78.
[15]谢朝云,覃家露,熊芸,等.呼吸机相关性肺部多药耐药菌感染的影响因素分析[J].中华医院感染学杂志,2018,28(13):2067-2071.
[16] Hak E,Shea KM,Jick SS.Association of infant pneumococcal vaccination with pneumococcal pneumonia among mothers:a nested case-control study using the GPRD[J].Vaccine,2013,31(12):1590-1596.
[2] Rouze A,Jaillette E,Nseir S.Continuous control of tracheal cuff pressure:an effective measure to prevent ventilator-associated pneumonia?[J].Critical care,2014,18(5):512.
[3] Sundar KM,Thaut P,Nielsen DB,et al.Clinical course of ICU patients with severe pandemic 2009influenza A(H1N1)pneumonia:single center experience with proning and pressure release ventilation.[J].J Intensive Care Med,2012,27(3):184-190.
[4] Bhuiyan MU,Snelling TL,West R,et al.Role of viral and bacterial pathogens in causing pneumonia among Western Australian children:a casea control study protocol[J].BMJ Open,2018,8(3):e020646.
[5]陈仁辉,陶福正,陈英姿,王俊青,陈曦.呼吸机相关性肺炎的危险因素与病原菌分析[J].中华医院感染学杂志,2014,24(24):6042-6044.
[6]闵新珍,黄汉鹏,戴春晖,等.呼吸机相关性肺炎的影响因素及预防对策研究[J].中华医院感染学杂志,2018,28(21):3230-3233.
[7]兰海平,黄旭晴,吕群.呼吸机相关性肺炎病原菌分析与耐药性研究[J].中华医院感染学杂志,2015,25(05):984-986.
[8]尚红,王毓三,申子瑜.主编全国临床检验操作规程(第4版)[M].北京,人民卫生出版社,2014:38-39.
[9]中华医学会重症医学分会.呼吸机相关性肺炎诊断、预防和治疗指南(2013)[J].中华内科杂志,2013,52(6):524-543.
[10] Ishii M,Takeshita J,Ishiyama M,et al.Evaluation of the pathogenicity and infectivity of entomopathogenic hypocrealean fungi,isolated from wild mosquitoes in Japan and Burkina Faso,against female adult Anopheles stephensi,mosquitoes[J].Fungal Ecology,2015,15:39-50.
[11]王兆霞,张起,侯慧峰,等.呼吸机相关肺炎相关因素分析及综合干预措施的预防效果[J].中华医院感染学杂志,2018,28(19):2924-2927.
[12] Park SA,Cho SS,Kwak GJ.Factors influencing ventilatorassociated pneumonia in cancer patients[J].Asian Pac J Cancer Prev,2014,15(14):5787-5791.
[13] Alpkvist H,Athlin S,Molling P,et al.High HMGB1levels in sputum are related to pneumococcal bacteraemia but not to disease severity in community-acquired pneumonia[J].Sci Rep,2018,8(1):13428.
[14]李淑媛,盖鑫,张建,等.ICU机械通气患者呼吸机相关性肺炎危险因素与干预措施[J].中华医院感染学杂志,2016,26(1):76-78.
[15]谢朝云,覃家露,熊芸,等.呼吸机相关性肺部多药耐药菌感染的影响因素分析[J].中华医院感染学杂志,2018,28(13):2067-2071.
[16] Hak E,Shea KM,Jick SS.Association of infant pneumococcal vaccination with pneumococcal pneumonia among mothers:a nested case-control study using the GPRD[J].Vaccine,2013,31(12):1590-1596.