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呼吸机相关性肺炎的危险因素及细菌耐药性分析

发布时间:2018-05-29 10:39

  本文选题:呼吸机相关性肺炎 + 病原菌 ; 参考:《西南医科大学》2017年硕士论文


【摘要】:目的:通过研究邛崃市医疗中心医院重症监护病房(ICU)呼吸机相关性肺炎(VAP)住院患者的临床特点、病原菌的耐药性以及VAP相关危险因素,为临床上预防及个体化治疗VAP提供科学依据。方法:邛崃市医疗中心医院2015年01月 2016年10月472例ICU住院患者纳入本次研究,收集患者年龄、性别、APACHEII评分、意识状态、口咽部微生物定植、胃液微生物定植、湿化器微生物定植、冷凝器微生物定植、螺纹管微生物定植、H2受体阻断剂应用、机械通气时间及机械通气方式、VAP发病情况等资料,采用单因素及Logistic回归分析危险因素;对发生VAP的住院患者用无菌吸痰管从下呼吸道采集分泌物先进行痰涂片检查合格后再进行细菌培养,所有菌株采用VITEK微生物全自动分析仪进行细菌鉴定,并对分离出的主要菌株用K-B法对常用抗生素进行药敏实验,以美国临床和实验室标准化协会(CLSI)2014版判断标准判断药敏结果。结果:(1)本组472患者有184例发生VAP,发生率为38.98%。(2)单因素分析结果显示,患者年龄、APACHEII评分、意识状态、口咽部微生物定植、机械通气时间、湿化器微生物定植、冷凝器微生物定植、螺纹管微生物定植及机械通气方式等因素与VAP发生有关(P0.05),而患者性别、胃液微生物定植、H2受体阻断剂等因素与VAP发生无关(P0.05)。(3)Logistic回归分析结果显示,年龄、APACHEII评分、机械通气时间、机械通气方式和湿化器微生物定植是VAP的影响因素。(4)送检样本中分离病原菌141株,其中革兰阳性菌21株(14.89%)、革兰阴性菌101株(71.63%),真菌19株(13.48%)。(5)本组检出率最高的病原菌依次为鲍曼不动杆菌34株(23.94%)、肺炎克雷伯菌28株(19.86%)、白假丝酵母菌17株(12.06%)、铜绿假单胞菌16株(11.35%)、金黄色葡萄球菌11株(7.80%)。(6)鲍曼不动杆菌对舒巴坦、亚胺培南、青霉素类和头孢类抗生素耐药率较高,对复方新诺明耐药率较低。(7)肺炎克雷伯菌对头孢拉定、阿莫西林和氨苄西林耐药率达100%,对头孢他啶和哌拉西林敏感,对亚胺培南、氨曲南和左氧氟沙星耐药率较低,对头孢类抗生素耐药率均较高。(8)铜绿假单胞菌对庆大霉素和妥布霉素敏感,对亚胺培南、左旋氧氟沙星及环丙沙星耐药率较低,对大多数头孢类抗生素耐药率较高。(9)金黄色葡萄球菌对除阿莫西林外其他常用抗生素耐药率较低,对呋喃妥因、庆大霉素及复方新诺明均不耐药。(10)大肠埃希菌对多种抗菌药物耐药,对青霉素类、头孢类及喹诺酮抗生素类几乎完全耐药,对哌拉西林他唑巴坦耐药率较低,但对亚胺培南敏感。结论:(1)邛崃市医疗中心医院重症监护病房(ICU)住院患者VAP病原菌感染形势严峻。(2)VAP的发生与患者年龄、APACHEII评分、湿化器微生物定植、机械通气时间以及机械通气方式有关。(3)VAP病原菌以革兰氏阴性杆菌为主,并有多重耐药。
[Abstract]:Objective: to study the clinical characteristics of patients with ventilator associated pneumonia (VAP) in the intensive care unit (ICU) of Qionglai City Medical Center Hospital, the drug resistance of pathogenic bacteria and the risk factors associated with VAP. To provide scientific basis for clinical prevention and individualized treatment of VAP. Methods: 472 ICU inpatients from January 2015 to October 2016 in Qionglai City Medical Center Hospital were included in the study. The patients' age, sex and Apache II scores, consciousness status, oropharyngeal microorganism colonization and gastric juice microorganism colonization were collected. The data of humidifier microorganism colonization, condenser microorganism colonization, threaded tube microorganism colonization and H _ 2 receptor blocker application, mechanical ventilation time and mechanical ventilation mode were analyzed by single factor and Logistic regression analysis. Sputum smears were collected from the lower respiratory tract with aseptic sputum suction tube in the inpatients with VAP. All the strains were identified by VITEK microorganism automatic analyzer. K-B method was used to test the susceptibility of common antibiotics, and the results were judged by CLSI 2014 standard of American Association of Clinical and Laboratory Standardization. Results among the 472 patients, 184 cases (38.98%) developed VAPs. The results of univariate analysis showed that the age of the patients was APACHEII score, consciousness state, oropharyngeal microorganism colonization, mechanical ventilation time, humidifier microorganism colonization, condenser microorganism colonization. Factors such as microbiological colonization of threaded tube and mechanical ventilation mode were related to the occurrence of VAP (P 0.05), but the sex of patients, gastric microorganism colonization and H 2 receptor blocker were not related to the occurrence of VAP. Logistic regression analysis showed that age, Apache II score and mechanical ventilation time were not related to the occurrence of VAP. Mechanical ventilation and humidifier microorganism colonization were the influencing factors of VAP. Among them, 21 strains of Gram-positive bacteria, 101 strains of Gram-negative bacteria, and 19 strains of fungi, respectively, have the highest detectable rate of Acinetobacter baumannii, Klebsiella pneumoniae, Klebsiella pneumoniae, Candida albicans, Candida albicans, Pseudomonas aeruginosa, and Pseudomonas aeruginosa, respectively. 16 strains of Acinetobacter baumannii, 11 strains of Staphylococcus aureus, 11 strains of Staphylococcus aureus, The resistance rate of imipenem, penicillin and cefazolin antibiotics was higher, and the resistance rate of Klebsiella pneumoniae to cefradine, amoxicillin and ampicillin was 100, and was sensitive to ceftazidime and piperacillin, and the resistance rate of Klebsiella pneumoniae to cefradine, amoxicillin and ampicillin was 100%, and it was sensitive to ceftazidime and piperacillin. The resistance rates to imipenem, aztreonam and levofloxacin were lower, and those to cephalosporin antibiotics were higher. Phaeomonas aeruginosa were sensitive to gentamicin and tobramycin, but to imipenem, levofloxacin and ciprofloxacin. Staphylococcus aureus has a lower resistance rate to other commonly used antibiotics except amoxicillin, and is more resistant to furantoin, while Staphylococcus aureus has higher resistance to most cephalosporins. Escherichia coli was resistant to many antibiotics, almost completely to penicillin, cephalosporins and quinolones, but low to piperacillin tazobactam. But sensitive to imipenem. Conclusion (1) in the intensive care unit (ICU) of Qionglai City Medical Center Hospital, the incidence of VAP pathogenic bacteria infection in the inpatients was severe, and the age of the patients was evaluated with Apache II score, and the humidifier microorganism was colonized. The main pathogens of VAP were Gram-negative bacilli and multidrug resistance.
【学位授予单位】:西南医科大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R563.1

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