ICU患者呼吸机相关性肺炎多药耐药菌感染影响因素与预防分析
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摘要
目的探讨重症监护病房(ICU)患者呼吸机相关性肺炎(VAP)多药耐药菌感染特点与影响因素。方法回顾性分析2016年6月-2017年10月于医院ICU接受气管插管机械通气治疗并发生VAP的患者96例的临床资料,对多药耐药菌感染病原菌与耐药性进行研究;对患者性别、年龄、通气时间等临床资料进行分析,归纳ICU患者发生VAP多药耐药菌感染的影响因素。结果 96例患者发生多药耐药菌感染58例;96例ICU VAP患者痰培养共培养分离病原菌205株,其中革兰阴性菌163株占79.51%,以肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌为主;革兰阳性菌34株占16.59%,以金黄色葡萄球菌、表皮葡萄球菌为主;真菌8株占3.90%;主要革兰阴性菌对常用抗菌药物均存在一定的耐药性,鲍氏不动杆菌存在严重的耐药性,对常用抗菌药物耐药率均>80%,主要革兰阴性菌均对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦较敏感;金黄色葡萄球菌对万古霉素、磺胺甲噁唑/甲氧苄啶、替考拉宁敏感。机械通气时间、入住ICU时间、血清白蛋白、抗菌药物使用时间是ICU患者发生VAP多药耐药菌感染的影响因素(P<0.05)。结论 ICU患者发生VAP多药耐药菌感染以革兰阴性菌为主,耐药形势严峻,临床应针对病原菌给予敏感抗菌药物进行治疗,针对感染影响因素给予相应护理措施。
OBJECTIVE To investigate the characteristics and influencing factors of ventilator-associated pneumonia(VAP)caused by multi-drug resistant organisms in intensive care unit(ICU)patients.METHODS The clinical data of 96 patients with VAP who underwent tracheal intubation mechanical ventilation in ICU of the hospital from Jun.2016 to Oct.2017 were retrospectively analyzed.The pathogens and drug resistance of multidrug resistant organisms were studied.Clinical data such as gender,age,and ventilation time of the patients were analyzed to summarize the influencing factors of VAP caused by multi-drug resistant organisms infection in ICU patients.RESULTS 58 cases of multi-drug resistant organisms infection occurred in the 96 patients.From the sputum specimens of the 96 cases of ICU VAP patients,205 pathogens were cultured and isolated,of which 163 strains of gram-negative bacteria accounted for 79.51%,with Klebsiella pneumoniae,Pseudomonas Aeruginosa,Acinetobacter baumannii and Escherichia coli as the main pathogens,34 strains of gram-positive bacteria accounted for16.59%,mainly Staphylococcus aureus and Staphylococcus epidermidis,and 8 strains of fungi accounted for3.90%.The main gram-negative bacteria were resistant to common antibiotics.Acinetobacter baumannii had serious drug resistance,and the resistance rates to commonly used antibiotics were all>80%.The main gramnegative bacteria were all sensitive to cefoperazone/sulbactam,piperacillin/tazobactam,whereas S aureus was sensitive to vancomycin,sulfamethoxazole/trimethoprim and teicoplanin.Mechanical ventilation time,ICU stay,albumin,and antibacterial use time were the influencing factors of VAP multidrug-resistant organism infection in ICU patients(P<0.05).CONCLUSION The infection of VAP multidrug-resistant organisms in ICU patients is mainly caused by gram-negative bacteria,and the drug resistance situation is severe.Clinically,sensitive antibiotics should be given according to the pathogens,and corresponding nursing measures should be given for the factors affecting infection.
OBJECTIVE To investigate the characteristics and influencing factors of ventilator-associated pneumonia(VAP)caused by multi-drug resistant organisms in intensive care unit(ICU)patients.METHODS The clinical data of 96 patients with VAP who underwent tracheal intubation mechanical ventilation in ICU of the hospital from Jun.2016 to Oct.2017 were retrospectively analyzed.The pathogens and drug resistance of multidrug resistant organisms were studied.Clinical data such as gender,age,and ventilation time of the patients were analyzed to summarize the influencing factors of VAP caused by multi-drug resistant organisms infection in ICU patients.RESULTS 58 cases of multi-drug resistant organisms infection occurred in the 96 patients.From the sputum specimens of the 96 cases of ICU VAP patients,205 pathogens were cultured and isolated,of which 163 strains of gram-negative bacteria accounted for 79.51%,with Klebsiella pneumoniae,Pseudomonas Aeruginosa,Acinetobacter baumannii and Escherichia coli as the main pathogens,34 strains of gram-positive bacteria accounted for16.59%,mainly Staphylococcus aureus and Staphylococcus epidermidis,and 8 strains of fungi accounted for3.90%.The main gram-negative bacteria were resistant to common antibiotics.Acinetobacter baumannii had serious drug resistance,and the resistance rates to commonly used antibiotics were all>80%.The main gramnegative bacteria were all sensitive to cefoperazone/sulbactam,piperacillin/tazobactam,whereas S aureus was sensitive to vancomycin,sulfamethoxazole/trimethoprim and teicoplanin.Mechanical ventilation time,ICU stay,albumin,and antibacterial use time were the influencing factors of VAP multidrug-resistant organism infection in ICU patients(P<0.05).CONCLUSION The infection of VAP multidrug-resistant organisms in ICU patients is mainly caused by gram-negative bacteria,and the drug resistance situation is severe.Clinically,sensitive antibiotics should be given according to the pathogens,and corresponding nursing measures should be given for the factors affecting infection.
引文
[1]张素花,朱进,李秀华,等.呼吸机相关性肺炎的病原学特点及对预后的影响[J].内科急危重症杂志,2016,22(3):190-193.
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[9] Bagheri-Nesami M,Rezai MS,Ahangarkani F,et al.Multidrug and co-resistance patterns of non-fermenting gramnegative bacilli involved in ventilator-associated pneumonia carrying class 1integron in the North of Iran.[J].Germs,2017,7(3):123-131.
[10] Falagas ME,Kopterides P.Risk factors for the isolation of multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa:a systematic review of the literature[J].J Hosp Infect,2006,64(1):7-15.
[11] Souli M,Galani I,Giamarellou H.Emergence of extensively drug-resistant and pandrug-resistant gram-negative bacilli in Europe[J].Euro Surveill,2008,13(47):19045.
[12] Kidd JM,Kuti JL,Nicolau DP,et al.Novel pharmacotherapy for the treatment of hospital-acquired and ventilator-associated pneumonia caused by resistant gram-negative bacteria[J].Expert Opin Pharmacother,2018,19(4):397-408.
[13]Mukhopadhyay C,Bhargava A,Ayyagari A.Role of mechanical ventilation&development of multidrug-resistant organisms in hospital acquired pneumonia[J].Indian J Med Res,2003,118:229-235.
[14]刘郁.我院2013~2015年肺炎克雷伯菌临床分布及耐药性分析[J].中国现代医药杂志,2016,18(10):67-69.
[15] Wilson AP,Livermore DM,Otter JA,et al.Prevention and control of multi-drug-resistant gram-negative bacteria:recommendations from a Joint Working Party[J].J Hosp Infect,2016,92:S1-S44.
[16] Campbell W R,Li P,Whitman TJ,et al.Multidrug–resistant gram-negative infections in deployment-related trauma patients[J].Surg Infect,2017,18(3):357-367.
[2]王帅,安里占.呼吸机相关性肺炎的感染途径及病原菌分布调查分析[J].中国医学装备,2017,14(1):35-38.
[3]李福琴,杨阳,张梦华,等.ICU呼吸机相关性肺炎患者病原菌分布与耐药性分析[J].中华医院感染学杂志,2016,26(11):2497-2499.
[4]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.
[5]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.
[6] Kollef MH,Burnham CD.Ventilator-associated pneumonia:the role of emerging diagnostic technologies.[J].Semin Respir Crit Care Med,2017,38(3):253-263.
[7] Liu C,Zhang YT,Peng ZY,et al.Aerosolized amikacin as adjunctive therapy of ventilator-associated pneumonia caused by multidrug-resistant gram-negative bacteria:a single-center randomized controlled trial[J].Chin Med J,2017,130(10):1196-1201.
[8]叶倩,杨莹,王善梅,等.多重耐药菌目标性监测结果分析及效果评价[J].预防医学情报杂志,2016,32(10):1041-1044.
[9] Bagheri-Nesami M,Rezai MS,Ahangarkani F,et al.Multidrug and co-resistance patterns of non-fermenting gramnegative bacilli involved in ventilator-associated pneumonia carrying class 1integron in the North of Iran.[J].Germs,2017,7(3):123-131.
[10] Falagas ME,Kopterides P.Risk factors for the isolation of multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa:a systematic review of the literature[J].J Hosp Infect,2006,64(1):7-15.
[11] Souli M,Galani I,Giamarellou H.Emergence of extensively drug-resistant and pandrug-resistant gram-negative bacilli in Europe[J].Euro Surveill,2008,13(47):19045.
[12] Kidd JM,Kuti JL,Nicolau DP,et al.Novel pharmacotherapy for the treatment of hospital-acquired and ventilator-associated pneumonia caused by resistant gram-negative bacteria[J].Expert Opin Pharmacother,2018,19(4):397-408.
[13]Mukhopadhyay C,Bhargava A,Ayyagari A.Role of mechanical ventilation&development of multidrug-resistant organisms in hospital acquired pneumonia[J].Indian J Med Res,2003,118:229-235.
[14]刘郁.我院2013~2015年肺炎克雷伯菌临床分布及耐药性分析[J].中国现代医药杂志,2016,18(10):67-69.
[15] Wilson AP,Livermore DM,Otter JA,et al.Prevention and control of multi-drug-resistant gram-negative bacteria:recommendations from a Joint Working Party[J].J Hosp Infect,2016,92:S1-S44.
[16] Campbell W R,Li P,Whitman TJ,et al.Multidrug–resistant gram-negative infections in deployment-related trauma patients[J].Surg Infect,2017,18(3):357-367.