重症监护病房早发与晚发呼吸机相关性肺炎病原体耐药性差异
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蒋述科

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R181.3+2

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Difference in drug resistance of pathogens causing early and lateonset ventilatorassociated pneumonia in an intensive care unit
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    摘要:

    目的了解某院重症监护病房(ICU)呼吸机相关性肺炎(VAP)发生及病原菌耐药情况。方法对该院ICU 2011年1月—2012年12月间使用机械通气时间>48 h的住院患者VAP发生情况进行调查,比较早发VAP(EVAP,机械通气时间≤4 d)和晚发VAP(LVAP,机械通气时间>4 d)病原菌及其耐药情况。结果共调查患者176例,VAP发生率为44.32%(78例);随着呼吸机使用时间的延长,VAP的发生率逐渐增高(χ2=52.561,P<0.001)。LVAP发生率为58.33%(70/120),显著高于EVAP的14.29%(8/56),差异有统计学意义(χ2=30.02,P<0.001)。分离病原体178株,其中革兰阴性(G-)菌104株(58.43%),革兰阳性(G+)菌46株(25.84%)、真菌28株(15.73%);分离多重耐药菌/泛耐药菌97株(54.49%)。LVAP患者多重耐药菌/泛耐药菌分离率(58.86%,93株)显著高于EVAP患者(20.00%,4株),LVAP患者分离的主要病原菌耐药率显著高于EVAP患者(均P<0.05))。真菌感染仅发生在LVAP患者,其总体耐药率为12.14%。结论呼吸机使用时间的延长,可增加VAP的发生率;LVAP患者感染的病原体耐药率高。

    Abstract:

    ObjectiveTo study the incidence of ventilatorassociated pneumonia(VAP)and antimicrobial resistance of pathogens in an intensive care unit(ICU).MethodsThe occurrence of VAP in hospitalized patients with mechanical ventilation >48 hours between January 2011 and December 2012 were investigated, species and antimicrobial resistance of pathogens causing early onsetVAP (EVAP, mechanical ventilation≤4 d)and lateonset VAP(LVAP,mechanical ventilation >4 d) were compared.ResultsA total of 176 patients were investigated,incidence of VAP was 44.32%(78 cases);With the prolongation of mechical ventilation,incidence of VAP increased gradually (χ2=52.561,P<0.001).The incidence of LVAP was significantly higher than EVAP (58.33% [70/120] vs 14.29% [8/56])(χ2=30.02,P<0.001).A total of 178 pathogens were isolated, gramnegative bacteria,grampositive bacteria and fungi were 104(58.43%),46(25.84%),and 28(15.73%) isolates respectively; 97(54.49%) multidrugresistance/pandrug resistance organisms (MDRO) were isolated. MDRO isolation rate in LVAP patients was higher than EVAP patients([58.86%,n=93] vs [20.00%,n=4]),resistance rate of major pathogens causing LVAP was significantly higher than EVAP patients(all P<0.05).Fungi infection only occurred in LVAP patients, the total antimicrobial resistance rate was 12.14%.ConclusionThe prolongation of mechanical ventilation can increase the incidence of VAP, and resistance rate of pathogen in LVAP is high.

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蒋述科,罗彪峰,李荣明,等.

重症监护病房早发与晚发呼吸机相关性肺炎病原体耐药性差异[J]. 中国感染控制杂志,2014,13(4):208-211. DOI:10.3969/j. issn.1671-9638.2014.04.004.
JIANG Shuke, LUO Biaofeng, LI Rongming, et al. Difference in drug resistance of pathogens causing early and lateonset ventilatorassociated pneumonia in an intensive care unit[J]. Chin J Infect Control, 2014,13(4):208-211. DOI:10.3969/j. issn.1671-9638.2014.04.004.

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  • 收稿日期:2013-08-22
  • 最后修改日期:2013-10-23
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  • 在线发布日期: 2014-04-30
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