慢性阻塞性肺疾病急性加重期318例的呼吸机相关性肺炎预测指标和微生物学特征分析

目的 探讨慢性阻塞性肺疾病(COPD)急性加重期呼吸机相关性肺炎(VAP)的预测指标和微生物学特征.方法 以2016年12月至2019年12月聊城市第二人民医院呼吸内科收治的COPD急性加重期318例为研究对象,根据是否发生VAP分为VAP组和非VAP组.记录病人基线人口统计学信息及临床特征.采用多因素logistic...

Predictors and microbiological characteristics of ventilator-associated pneumonia in patients with chronic obstructive pulmonary disease

Objective To investigate the predictors and microbiological characteristics of ventilator-associated pneumonia (VAP) in patients with chronic obstructive pulmonary disease (COPD).Methods A total of 318 patients with exacerbation of COPD who were ad mitted to the Department of Respiratory Medicine, Liaocheng Second People''s Hospital from December 2016 to December 2019 were se lected as the research subjects. They were assigned into VAP group and non-VAP group according to whether VAP occurred. Baselinedemographic information and clinical characteristics of patients were recorded. Multivariate Logistic regression was used to analyze thepredictors of VAP in patients with COPD exacerbation. Microbiology diagnosis was performed by Gram stain smear and microscopy, andculture and drug sensitivity tests were performed on the specimens.Results The duration of COPD, the duration of deterioration before hospitalization, apache-2 score, SOFA score at admission, VAP patients were 10.38 (8.50, 12.27) years, (8.65±2.69) days, (21.24±2.57)points and (7.55±2.33) points respectively, and non VAP patients were 3.90 (2.40, 8.40) years, (5.22±2.16) days, (16.26±2.46) pointsand (4.34±1.50) points respectively. There was significant difference between the two groups (P<0.01). Compared with non-VAP pa tients, the proportion of multiple hospitalizations due to COPD, history of tuberculosis, diabetes, re-intubation after admission, use of va sopressors during admission, antibiotics used in the past 90 days in VAP patients were increased significantly (P<0.05). Multivariate Lo gistic regression analysis showed multiple hospitalizations due to COPD, diabetes, APACHE-2 score, SOFA score at admission, reintuba tion after admission, and antibiotic use in the past 90 days were important predictors of VAP in patients with COPD exacerbation (ORvalues were 67.128, 12.996, 2.352, 2.054, 7.253 and 3.546 respectively). Gram-negative bacteria were present in 57 (100%) VAP pa tients with bronchoalveolar lavage (BAL) or intratracheal aspiration (ETA) specimens. Acinetobacter baumannii was the most commonmicroorganism (n=27, 47.3%), followed by Klebsiella pneumoniae (n=18, 31.6%), Pseudomonas aeruginosa (n=3, 5.3%), and Enterobac ter (n=3, 5.3%). All pathogens were multidrug-resistant.Conclusion Multiple hospitalizations due to COPD, diabetes, APACHE-2 score, SOFA score at admission, reintubation after admission, and antibiotic use in the past 90 days were independent predictors ofVAP in patients with COPD exacerbation. Antimicrobial treatment of VAP should cover multi-drug resistant Gram-negative bacteria.