急诊科重症监护室呼吸机相关性肺炎的病原菌与危险因素分析

目的探讨急诊科重症监护室(EICU)呼吸机相关性肺炎(VAP)的病原菌分布和危险因素。方法采集2018年1月-12月本院EICU收治的149例行机械通气患者痰标本,进行微生物培养和鉴定,回顾性分析其危险因素。结果149例机械通气患者发生VAP 61例,发生率为40.94%。VAP患者共检出病原菌72株,其中革兰阴性菌占69.44%,革兰阳性菌占19.44%,真菌占11.11%;铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌、金黄色葡萄球菌和表皮葡萄球菌为主要致病菌。VAP的感染率与年龄、机械通气时间、是否合并基础疾病、是否存在侵入性操作、气管切开、联合用药呈相关性(P<0.05)。结论VAP主要致病菌为革兰阴性菌,年龄、机械通气时间是主要危险因素,应采取有效的干预措施降低VAP的感染率。

Pathogens and risk factors of ventilator-associated pneumonia in EICU

Objective To investigate the pathogenic bacteria distribution and risk factors of ventilator-associated pneumonia(VAP)in emergency intensive care unit(EICU).Methods A total of 149 sputum specimens from patients undergoing mechanical ventilation in EICU from January 2018 to December 2018 were collected for microbial culture and identification,and the risk factors were analyzed retrospectively.Results There were 61 VAP cases in 149 patients with mechanical ventilation,and the incidence was 40.94%.72 strains of pathogens were detected in VAP patients,of which 69.44%were gram-negative bacteria,19.44%were Gram-positive bacteria and 11.11%were fungi.Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli,Staphylococcus aureus and Staphylococcus epidermidis were the main pathogens.Age,duration of mechanical ventilation,merger of underlying diseases,presence of invasive procedures,tracheotomy and combination of drugs are important risk factors for VAP.Conclusion Gram-negative bacteria are the main pathogens of VAP.Age and duration of mechanical ventilation are the main risk factors.Effective interventions should be taken to reduce the infection rate of VAP.