ICU呼吸机相关性肺炎病原菌耐药性变迁及影响因素分析

摘要 目的 探索重症监护病房(ICU)呼吸机相关性肺炎(VAP)病原菌耐药性变迁情况以及影响VAP发生的主要因素。方法 采用回顾性调查方法，选取某医院2014年1月-2017年12月ICU确诊VAP患者为研究对象，分析连续4年医院ICU VAP的发生率、检出病原菌及耐药性变化情况，此外采用单因素及多因素Logistic方法分析影响VAP发生的主要因素。结果 2014-2017年VAP发生率分别为10.44‰、6.19‰、5.58‰和4.39‰，趋势性检验有统计学意义(χ2=9.339，P＜0.01)，革兰阴性菌检出比例由72.09%升高至85.19%，且检出菌耐药比例增高，其中鲍曼不动杆菌、铜绿假单胞菌对亚胺培南/美罗培南、阿米卡星和环丙沙星的耐药率均显著增高。单因素及多因素Logistic结果显示住ICU时间、机械通气时间、是否联合用药等是VAP发生的主要危险因素。结论 ICU呼吸机相关性肺炎在不断强化感控措施落实的基础上呈现出显著下降趋势，革兰阴性菌仍是ICU VAP的主要病原菌，且呈显著增高趋势，应有针对性开展ICU目标性监测，规范抗菌药物的使用。

Analysis of drug resistance changes and their influencing factors of pathogens in ventilator-associated pneumonia in ICU

Objective Objective To explore the changes of drug resistance of pathogens in ventilator-associated pneumonia( VAP) in ICU and the main factors affecting the occurrence of VAP. Methods Retrospective investigation was used to analyze the incidence,pathogens and drug resistance of VAP in ICU of a hospital from January 2014 to December 2017. In addition,one-way ANOVA and multiple Logistic regression analysis was used to analyze the main factors affecting VAP.Results The incidence of VAP were 10. 44‰,6. 19‰,5. 58‰,4. 39‰ from 2014 to 2017,and the trend test was statistically significant( χ~2= 9. 339,P < 0. 01). In the detection of pathogenic bacteria,the detection of Gram-negative bacteria increased from 72. 09% to 85. 19% and the proportion of drug resistant bacteria increased. The resistance rates of Acinetobacter baumanii and Pseudomonas aeruginosa to imipenem/meropenem,amikacin and ciprofloxacin were significantly increased. Univariate and multiple Logistic regression analysis showed that time in ICU,duration of mechanical ventilation and whether drug combination were the main risk factors of VAP. Conclusion VAP in ICU shows a significant downward trend on the basis of continuously strengthening the implementation of infection control measures. Gram-negative bacteria are still the main pathogens of VAP in ICU of medical institutions,and show a significant upward trend. It is necessary to carry out targeted surveillance in ICU,standardize the use of antibiotics.