多重耐药菌所致呼吸机相关肺炎的治疗及预后

发布时间：2018-04-19 12:10

本文选题：呼吸机相关肺炎 + 多重耐药菌　；参考：《中国感染控制杂志》2017年09期

【摘要】：目的探讨多重耐药菌(MDRO)所致的呼吸机相关肺炎(VAP)的治疗情况,及影响预后的相关因素。方法收集某院2012年1月—2013年12月住院的169例VAP病例,其中MDRO感染组125例及非MDRO感染组44例。MDRO感染组分为MDR-A组(对选用抗菌药物均耐药)78例和MDR-B组(对选用抗菌药物至少一种敏感)47例。分析比较各组间抗菌药物选用及预后情况。结果 VAP气道内分泌物共分离病原菌242株,其中MDRO173株(71.49%)。VAP主要的病原菌有克雷伯菌属(66株)、铜绿假单胞菌(64株)、不动杆菌属(60株)、金黄色葡萄球菌(27株)、大肠埃希菌(17株),其中MDRO占各菌的比率为68.18%、50.00%、91.67%、88.89%、76.47%。MDRO感染组较非MDRO感染组预后差,MDR-A组预后最差(P0.001)。VAP患者持续发热、白细胞升高及肺部炎症进展亦提示预后不佳(均P0.001);治疗有效患者发病前、起始和培养后敏感抗菌药物的使用均高于病情恶化的患者(均P0.001),而昏迷、早发VAP、多种细菌感染对VAP患者无预后意义(均P0.05)。结论 VAP患者MDRO感染高发,使用有效抗菌药物治疗可改善预后。
[Abstract]:Objective to investigate the treatment and prognostic factors of ventilator associated pneumonia (VAP) caused by multidrug resistant bacteria MDRO.Methods 169 cases of VAP were collected from January 2012 to December 2013 in a hospital.MDRO infection group (n = 125) and non- infection group (n = 44) were divided into MDR-A group (n = 78) and MDR-B group (n = 47).The selection and prognosis of antimicrobial agents in each group were analyzed and compared.Results A total of 242 strains of pathogenic bacteria were isolated from VAP airway secretions.The main pathogens of MDRO173 are 66 strains of Klebsiella, 64 strains of Pseudomonas aeruginosa, 60 strains of Acinetobacter, 27 strains of Staphylococcus aureus and 17 strains of Escherichia coli, among which the ratio of MDRO to each bacteria is 68.1850.0091.678.8988.8976.47.The prognosis of MDRO infection group was worse than that of MDR-A group.Leukocyte elevation and pulmonary inflammatory progression also indicated poor prognosis (all P 0.001). The use of sensitive antimicrobial agents before onset and after culture in effective patients was higher than that in patients with exacerbation of the disease (all P 0.001 and coma, P 0.001).Early onset of VAP, multiple bacterial infections had no prognostic significance in VAP patients (all P 0.05).Conclusion there is a high incidence of MDRO infection in patients with VAP, and the use of effective antimicrobial agents can improve the prognosis.
【作者单位】：徐州医科大学附属医院;
【分类号】：R563.1

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