50例重症院内获得性肺炎的诊治分析

目的:观察重症院内获得性肺炎患者的细菌耐药情况和预后.方法:对50例重症HAP患者进行前瞻性观察研究,分析患者一般情况、初始痰培养和药物敏感性、机械通气时间以及病死率.结果:初始细菌培养阳性菌株53株,其中革兰阴性菌39株(73.6％),以铜绿假单胞菌(28.3％)、鲍曼不动杆菌(18.9％)、肺炎克雷伯杆菌(11.3％)为多见;革兰阳性菌14株(26.4％),均为耐甲氧西林金黄色葡萄球菌(MRSA).细菌耐药情况严重.所有患者30 d粗病死率为16％(8/50).在43例初始细菌培养阳性患者中,恰当初始抗生素应用率为63.8％ (27/43);治疗组恰当与不恰当组的机械通气时间分别为8.9±5.2d和15.4±10.1d,有显著性差异(P＜0.05);2组30d粗病死率分别为11.1％和25.0％,无显著性差异(P＞0.05).结论:重症院内获得性肺炎的致病菌耐药率高,恰当初始抗生素治疗可以降低机械通气时间.应加强细菌耐药监测及合理应用抗生素.     

综合重症监护病房院内感染病原菌分布及耐药性分析

目的 了解中心重症监护病房院内感染流行病学特点及细菌耐药性情况.方法 对本院中心重症监护病房2006年8月至2008年8月所分离致病菌的菌群分布及其耐药情况进行回顾性分析.结果 重症监护病房中共有214例发生院内感染,院内感染率为23.86%.共分离出致病菌493株,以革兰阴性杆菌为主,占58.01%,其中比例最高的为鲍曼不动杆菌(19.27%),其次为铜绿假单胞菌(8.92%)、肺炎克雷伯菌(6.90%).革兰阳性球菌占38.54%,比例最高为金黄色葡萄球菌(12.58%).真菌占3.45%.结论 革兰阴性杆菌仍为重症监护病房院内感染主要病原菌,其中非发酵菌比例较高,且呈现多重耐药趋势.合理使用抗生素,尽快完善各项病原学检查,减少高危因素并制定有效的防治措施显得更加重要.     

院内感染管理对重症监护室患者呼吸机相关性肺炎发生的影响

目的探究院内感染管理对重症监护室患者呼吸机相关性肺炎的作用及意义。方法选择我院2015年10月~2016年7月重症监护室收治的患者50例,根据随机数字表法将所有患者分为两组,对照组患者予以常规护理,观察组实施护理干预,比较两组患者呼吸机相关性肺炎的发生率及对医护人员的护理满意度。结果与对照组相比,观察组患者护理满意度高,呼吸机相关性肺炎发生率低,差异有统计学意义(P0.05)。结论院内管理可降低重症监护室患者呼吸机相关性肺炎的发生率,提高患者对医护人员的护理满意度,值得临床推广。     

院内多重耐药大肠埃希菌肺炎的耐药现状及影像学特征分析

目的 分析院内多重耐药大肠埃希菌(MDR-ECO)肺炎的耐药现状及影像学特征,并探讨发生MDR-ECO感染的危险因素.方法 选择2018-07-01～2020-06-30潍坊市人民医院经呼吸道或者血标本分离检测确认的大肠埃希菌所致院内获得性肺炎(HAP)患者178例的病历资料,根据致病菌是否为多重耐药菌将其分为MDR-...     

呼吸机相关性肺炎的病原学特点及其对临床预后的影响

目的：用回顾性研究的方法调查我院重症监护室呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的病原菌特点及其对临床预后的影响。方法：我们回顾性地调查了自2013年6月至2014年12月入住我院重症监护室并行机械通气＞48h的所有患者,根据是否发生呼吸机相关性肺炎而将这些患者分为呼吸机相关性肺炎组(VAP组)和非呼吸机相关性肺炎组(NON-VAP组),并对VAP组进行进一步分组,分为早发VAP组和晚发VAP组,对所有患者的呼吸道分泌物进行培养,同时观察各组患者的临床预后。结果：85例VAP患者中共分离出96株菌株,其中革兰氏阴性菌有79株(82.29%),以铜绿假单胞菌、鲍氏不动杆菌及肺炎克雷伯菌最常见；VAP患者中72例患者(84.71%)为单细菌感染,13例患者(15.29%)为多细菌感染；早发型VAP患者36例,共培养出38株致病菌,主要为肺炎克雷伯菌、铜绿假单胞菌及金黄色葡萄球菌,而晚发型VAP患者49例,共培养出58株致病菌,主要为鲍氏不动杆菌、铜绿假单胞菌及肺炎克雷伯菌；早发型VAP患者气道分泌物中培养出7株多重耐药菌,而晚发型VAP患者气道分泌物共培养出24株多重耐药菌,两组在多重耐药菌的检出率上差异有统计学意义(P=0.021)；早发型VAP和晚发型VAP的机械通气天数分别为8.49±4.36 vs. 26.06±14.90(P=0.001),总住院天数分别为28.11±25.51 vs. 42.88±31.41(P=0.020),30天病死率分别为50.00% vs.35.42%(P=0.180),60天死亡率分别为58.33% vs.45.83%(P=0.257)。VAP和NON-VAP组机械通气天数分别是16.82±38.83 vs.6.66±5.28(P=0.018),ICU住院天数分别为24.16±40.42 vs. 11.79±11.63(P=0.007),住院期间病死率分别为54.12% vs. 39.67%(P=0.023)。结论：我院ICU中VAP的致病菌以铜绿假单胞菌、鲍氏不动杆菌及肺炎克雷伯菌等革兰氏阴性杆菌最常见,其中早发型VAP致病菌以肺炎克雷伯菌、铜绿假单胞菌及金黄色葡萄球菌为主,而晚发型VAP致病菌以鲍氏不动杆菌、铜绿假单胞菌及肺炎克雷伯菌主；多重耐药菌更常见于晚发型VAP病例；晚发型VAP的机械通气时间及总住院时间较早发型VAP的延长,两组的病死率无显著差异；VAP延长ICU患者的机械通气时间及ICU治疗时间,也增加危重患者的住院期间病死率。     

新生儿肺炎优势病原体及耐药情况分析

目的探讨新生儿肺炎优势病原体及耐药情况。方法对新生儿社区获得性肺炎和院内感染性肺炎的痰标本进行病原学检测及耐药情况。结果 1.社区获得性肺炎及院内感染性肺炎病原学特征都为细菌感染多于病毒感染;2.医院内感染性肺炎检测出的病原菌较单一;3.革兰氏阳性菌对青霉素耐药率较高,对氯唑西林钠较敏感,革兰氏阴性菌对头孢曲松钠敏感率高。结论新生儿院内感染性肺炎病原相对单一,耐药率低。     

风险管理降低重症监护室呼吸机相关性肺炎的效果分析

目的探究风险管理降低重症监护室呼吸机相关性肺炎的效果。方法选取2015年3月~2016年5月商丘市第一人民医院重症监护室ICU进行机械通气治疗的患者100例为研究对象,随机分为两组,各50例。两组均实施常规管理,观察组在常规管理基础上实施风险管理。比较两组患者呼吸机相关性肺炎发生率及死亡率。结果对照组呼吸机相关性肺炎发生率及死亡率均比观察组高,差异有统计学意义(P0.05)。结论风险管理能够有效降低重症监护室呼吸机相关性肺炎发生率及死亡率,提高患者治疗效果,保障患者生命安全。     

呼吸机相关性肺炎的病原学调查

目的通过分析重症监护病房呼吸机相关性肺炎的病原学特点,对临床治疗提供依据。方法分析我院2003年9月~2004年8月重症监护病房收治的53例VAP患者的91株致病菌及其药物敏感情况。结果G-菌65例,占71.43%,以鲍曼不动杆菌,铜绿假单孢菌,阴沟肠杆菌为主,各占21.98%,17.58%,15.38%;G 菌22例,占24.18%,其中金黄色葡萄球菌占12.09%;真菌4例,占4.40%。多数细菌对抗生素耐药率较高。结论呼吸机相关性肺炎病原菌以G-菌为主且耐药率高,合理使用抗生素有助于预防和治疗VAP。     

翻身前口咽部和气囊上方分泌物吸引可降低呼吸机相关性肺炎的发生率

正呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)通常定义为有创机械通气48 h以后发生的肺炎,是重症监护室最常见的院内感染,占所有重症监护室院内感染的80%以上[1]。由于气管插管的建立,使得患者上呼吸道原有的加温加湿和免疫防御功能减弱、吞咽功能降低,大量的分泌物积聚在气囊上方和口咽部,而这些分泌物往往伴有大量的细菌。因此口咽部的分泌物一旦进入呼吸道,就会引起     

呼吸重症监护病房免疫功能低下患者肺炎病原学特点分析

目的 了解呼吸重症监护病房免疫功能低下患者(ICH)肺炎病原体特点及耐药情况,为临床经验性选择抗菌药物提供依据.方法 对2005年1月至2008年4月收住北京朝阳医院呼吸重症监护病房的52例ICH肺炎的痰或肺泡灌洗液培养及药敏试验结果进行回顾性分析.结果 52例ICH肺炎中20例医院获得性肺炎检出42株菌,其中革兰阴性杆菌15株(36.0%),以铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌为主;革兰阳性球菌13株(31.0%),以肠球菌属和金黄色葡萄球菌为主;真菌11株(26.2%),以曲霉菌和白色念珠菌为主;肺孢子菌3株(7.1%).32例社区获得性肺炎检出57株菌,其中革兰阴性杆菌19株(33.3%),以铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌为主;革兰阳性球菌16株(28.1%).以肠球菌和金黄色葡萄球菌为主;真菌16株(28.1%),以曲霉菌和白色念珠菌为主;肺孢子菌6株(10.5%).药敏试验显示铜绿假单胞菌对抗生素多重耐药率较高,鲍曼不动杆菌和肺炎克雷伯菌仍对碳青霉烯类较敏感.肠球菌属对万古霉素的耐药率为20.0%,未发现耐万古霉素的葡萄球菌.结论 ICH肺炎中的医院获得性肺炎和社区获得性肺炎病原学特点无差异,感染真菌和革兰阳性球菌比例较高,肺孢子菌肺炎应引起重视,多重耐药菌株高发,耐药率一致.     

导管相关血流感染临床分析

目的 分析我院2008年1月至2010年12月重症监护病房(ICU)和普通病房导管相关血流感染(CRBSI)的发生情况,为CRBSI的预防和治疗提供依据.方法 将我院131例CRBSI病例分为ICU组和普通病房组,对临床资料、病原菌、导管位置、预后等进行回顾性分析.结果 ICU组(88例)和普通病房组(43例)在年龄和...     

Effects of MBSR therapy on negative emotions,fatigue, and sleep quality in “post-ICU patients”: A randomized controlled clinical trial protocol

Background:Survivors of intensive care unit (ICU) transfer to the common ward are often accompanied by psychological distress, negative emotions, fatigue, and sleep disturbances that affect recovery. Mindfulness-based stress reduction (MBSR) has achieved reliable results in improving physical and mental health. However, no clinical study has been conducted to evaluate the effects of MBSR on negative emotions, fatigue and sleep quality of patients who survived ICU and were transferred to general wards.Methods:This is a prospective randomized controlled trial (RCT) examining the effects of MBSR on negative emotions, fatigue, and sleep quality in inpatients transferred from ICU to general ward. Participants were randomly divided into the treatment group and the control group in a ratio of 1:1. On the basis of the same nursing plan and health education, the treatment group received MBSR therapy, while the control group received no other interventions, and all the patients were followed up for 3 months after 2 weeks of continuous treatment. The indicators included negative mood indicators [Self-rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS)], fatigue index [Fatigue Severity Scale (FSS) and Brief Fatigue Inventory (BFI)], and sleep quality index [Pittsburgh Sleep Quality Index (PSQI)]. Finally, SPSS 20.0 software was used for statistical analysis of the data.Discussion:This study will evaluate the effects of MBSR on negative emotions, fatigue, and sleep quality in hospitalized patients transferred from ICU to general ward. The results of this study will provide a reference for MBSR to improve psychological distress in ICU survivors transferred to general ward.Trial registration:This study protocol was registered in the Open Science Framework (OSF) (registration number: DOI 10.17605/OSF.IO/PD7SU).     

2006—2008年鲍曼不动杆菌耐药性变迁分析

目的：通过分析鲍曼不动杆菌耐药性的变化,为临床治疗鲍曼不动杆菌感染提供帮助。方法：收集2006年1月—2008年12月我院所分离出的鲍曼不动杆菌,采用K-B琼脂扩散法进行药敏试验。结果：2006—2008年,呼吸道分离的鲍曼不动杆菌占分离的81.4%;鲍曼不动杆菌头孢哌酮/舒巴坦的耐药性较低,亚胺培南和美诺培南的耐药性上升很快,ICU和非ICU病房对抗生素的耐药率有较大的差异。结论：鲍曼不动杆菌耐药现象呈明显上升趋势,特别是亚胺培南和美诺培南。非ICU病房鲍曼不动杆菌的耐药率低于ICU病房。     

509株金黄色葡萄球菌感染的临床分布和耐药性分析

目的了解北京安贞医院金黄色葡萄球菌(SAU)在2011~2014年中的临床分布和耐药情况,为临床合理用药提供指导。方法回顾性分析2011年1月至2014年12月临床标本分离的509株SAU的分布及耐药性。采用vitek-Compact系统和Phoenix 100系统进行细菌鉴定,MIC法进行体外抗菌药物敏感试验。结果临床分离金黄色葡萄球菌(SAU)509株。SAU中有耐甲氧西林金黄色葡萄球菌(MRSA)286株,占56.2%。标本来源依次为呼吸道(52.1%)、血液(13.6%)和伤口分泌物(11.8%)。科室依次是重症监护室(31.9%)、心脏外科病房(11.6%)和呼吸内科病房(9.0%)。SAU对16种抗菌药物耐药率排在前3位的是青霉素占97.4%、红霉素占74.1%及克林霉素占69.9%;对利奈唑胺、万古霉素、替加环素和奎奴普丁-达福普丁的敏感率约为100%。结论我院分离的SAU耐药严重,尤其是MRSA多药耐药严重,在治疗金黄色葡萄球菌感染时应根据实验室结果合理选用敏感的抗菌药物。     

Pediatric Asthma Admissions: Chronic Severity and Acute Exacerbations

Factors resulting in intensive care unit (ICU) admissions for asthma exacerbations remain largely unclear. We compared ICU and general pediatric ward admissions for asthma exacerbations. Charts of 56 (2- to 18-year-old) patients admitted consecutively to the ICU during a 1-year period for asthma exacerbations were compared with charts of 56 age-, sex-, race-, and era-matched patients admitted to a general pediatric ward. Few patients in both groups received oral steroids before admission. Children with different chronic asthma severities had comparable severities of acute exacerbation. In conclusion, acute asthma exacerbations dissociate in severity from chronic asthma and are under-treated with systemic corticosteroids.     

Pediatric Asthma Admissions: Chronic Severity and Acute Exacerbations

Factors resulting in intensive care unit (ICU) admissions for asthma exacerbations remain largely unclear. We compared ICU and general pediatric ward admissions for asthma exacerbations. Charts of 56 (2- to 18-year-old) patients admitted consecutively to the ICU during a 1-year period for asthma exacerbations were compared with charts of 56 age-, sex-, race-, and era-matched patients admitted to a general pediatric ward. Few patients in both groups received oral steroids before admission. Children with different chronic asthma severities had comparable severities of acute exacerbation. In conclusion, acute asthma exacerbations dissociate in severity from chronic asthma and are under-treated with systemic corticosteroids.     

ICU呼吸机相关性肺炎病原学及其耐药性分析

目的探讨我院综合ICU呼吸机相关性肺炎（VAP）的病原菌分布及耐药情况。方法对我院ICU诊断为VAP的145例患者病原学资料进行分析。结果检出病原菌185株,其中革兰阴性（G-）杆菌141株（占76.2%）,前五位的G-菌分别是铜绿假单胞菌（46株）、肺炎克雷伯菌（24株）、鲍曼不动杆菌（17株）、大肠埃希菌（8株）和洋葱伯克霍尔德菌（8株）;革兰阳性（G＋）球菌17株（占9.2%）,主要为金黄色葡萄球菌（6株）,其中耐甲氧西林3株;真菌27株（占14.6%）。铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌和大肠埃希菌耐药率均〈30%的抗菌药物有头孢哌酮/舒巴坦、亚胺培南和美洛培南,铜绿假单胞菌耐药率〈30%的药物还有头孢他啶、妥布霉素、阿米卡星和奈替米星;洋葱伯克霍尔德菌耐药率〈30%的药物有哌拉西林/他唑巴坦、头孢他啶和复方新诺明。万古霉素、替考拉宁仍是院内G＋球菌特别是金黄色葡菌球菌的首选药物（耐药率为0%）。结论医院ICU中VAP病原菌以革兰阴性杆菌为主,细菌耐药普遍,临床需动态监测VA P病原菌及其耐药性,合理使用抗菌药物。     

The impact of critical illness on perceived health-related quality of life during ICU treatment, hospital stay, and after hospital discharge: a long-term follow-up study

BACKGROUND: The time course of changes in health-related quality of life (HRQOL) following discharge from the ICU and during a general ward stay has not been studied. We therefore studied the immediate impact of critical illness on HRQOL and its recovery over time. METHODS: In a prospective study, all patients admitted to the ICU for > 48 h who ultimately survived to follow-up at 6 months were included. The Medical Outcomes Study 36-item short form was used to measure HRQOL before ICU admission, at discharge from the ICU and hospital, and at 3 and 6 months following discharge from the ICU and hospital. An age-matched healthy Dutch population was used as a reference. RESULTS: Of the 451 included patients, 252 could be evaluated at 6 months (40 were lost to follow-up, and 159 died). Pre-ICU admission HRQOL in survivors was significantly worse compared to the healthy population. Patients who died between ICU admission and long-term follow-up had significantly worse HRQOL in all dimensions already at ICU admission when compared to the long-term survivors. HRQOL decreased in all dimensions (p < 0.001) during ICU stay followed by a rapid improvement during hospital stay, gradually improving to near pre-ICU admission HRQOL at 6 months following ICU discharge. Physical functioning (PF), general health (GH), and social functioning (SF) remained significantly lower than pre-ICU admission values. Compared to the healthy Dutch population, ICU survivors had significantly lower HRQOL 6 months following ICU discharge (except for the bodily pain score). CONCLUSIONS: A sharp multidimensional decline in HRQOL occurs during ICU admission where recovery already starts following ICU discharge to the general ward. Recovery is incomplete for PF, GH, and SF when compared to baseline values and the healthy population.     

Antibiotic sensitivity pattern of the bacteria isolated from nosocomial infections in ICU

The incidence of nosocomial infections in ICU is 4-5 times greater than in general ward. Critically ill patients are always at higher risk of developing nosocomial infections with resistant strains. This study is an attempt to know the antibiotic sensitivity pattern of the common isolates in ICU. Samples comprising urine, blood, endotracheal secretions and throat swabs were collected from 102 ICU patients of them, 56 patients showed evidence of nosocomial infection (54.9%), from whom 120 different organisms were isolated. Antibiotic sensitivity test was done according to Kirby Bauer method. Klebsiella pneumoniae were the most prevalent isolates from respiratory tract infections followed by Proteus spp, Escherichia coli, Staphylococci spp. and Acinetobacter spp. The gram negative enteric bacilli were uniformly resistant to betalactam antibiotics as well as betalactam-betalactamase inhibitors. Resistance to Ciprofloxacin and Ceftriaxone ranged from 50-100% and 25-83.3% respectively. Staphylococci were 100% resistant to penicillin and tetracycline, 80% to cotrimoxazole, 60% to erythromycin and gentamicin and 40% to amikacin. Acinetobacter spp. were highly resistant to most of the antibacterial agents except gentamicin while Pseudomonas spp. showed 75% resistance to it. The increased prevalence of resistant organisms in ICU probably reflects lack of proper antibiotic policy resulting in prolonged and indiscriminate use of antimicrobial agent.