呼吸机相关肺炎危险因素、病原体及耐药性分析

目的探讨呼吸机相关肺炎(VAP)发生的危险因素、病原体及耐药情况。方法采用回顾性调查对呼吸机相关肺炎发生的影响因素进行分析,对VAP患者气道分泌物进行细菌培养和药敏试验。结果机械通气时间>7天组VAP发生率明显高于≤7天组,应用H2受体阻滞剂组VAP的发生率较未用组高;VAP患者培养出病原菌79株,革兰阴性(G-)杆菌与革兰阳性(G )球菌分别为91.1%和6.3%。分离出的G-杆菌以铜绿假单胞菌、克雷伯杆菌、不动杆菌、大肠埃希菌为主,G-杆菌对多种抗生素有较高的耐药率,仅亚胺培南-西司他丁、哌拉西林-三唑巴坦、头孢他啶耐药率较低。结论减少机械通气时间、避免应用H2受体阻滞剂可减少VAP发生;VAP致病菌以革兰阴性杆菌为主,细菌耐药性严重,治疗上应选用敏感的抗菌药物。

ANALYSIS OF RISK FACTORS、PATHOGENS AND DRUG RESISTANCE IN VENTILATOR-ASSOCIATED PNEUMONIA

Objective To investigate the risk factors, pathogens and drug resistance in ventilator-associated pneumonia. Methods Retrospectively analyzed the influencing factors in the ventilator-asssociated pneumonia. Culture of bacteria and drug sensitivity tests were performed for the airway secretion of VAP patients. Results The occurrence of VAP in mechanical ventilation for 7-day group was markedly higher than that of shorter than 7-day group. Patients over 60 years of age had the occurrence of VAP significantly higher than those under 60 years of age. Occurrence of VAP was higher in patients using H2 receptor blockers than those without using these drugs. 79 strains of pathogens had been obtained by culture. Gram negative(G-) bacilli and Gram positive(G ) cocci occupied 91.1% and 6.3% respectively. G- bacilli isolated were chiefly pseudomonas aeroginosa, Klabsiella bacilli, amotile bacilli and B. coli. G- bacilli were drug resistant to many antibiotics. Only cystatin, paracillin and cephradine had relatively low drug resistance. Conclusions Reducing the time of mechanical ventilation, avoiding the use of H2 receptor blockers may reduce the occurrence of VAP. Pathogens for VAP are mainly Gram negative bacilli with strong drug resistance. In treatment, sensitive antibiotics should be selected.