多重耐药菌所致呼吸机相关肺炎的治疗及预后
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陈玉玲

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R181.3+2

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Therapy and prognosis of ventilatorassociated pneumonia caused by multidrugresistant organisms
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    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MDRO 173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(P<0.001)。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P<0.001);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P<0.001),而昏迷、早发VAP、多种细菌感染对VAP患者无预后意义(均P>0.05)。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:

    ObjectiveTo investigate the therapy and influencing factors for prognosis of ventilatorassociated pneumonia(VAP) caused by multidrugresistant organisms(MDROs). Methods169 patients with VAP who were admitted to a hospital between January 2012 and December 2013 were included in analysis, 125 were in MDRO infection group and 44 in nonMDRO infection group. MDRO infection group was subdivided into MDRA group(n=78, resistant to selected antimicrobial agents) and MDRB group (n=47, sensitive to at least one kind of selected antimicrobial agent). Antimicrobial choice and prognosis between each group were analyzed and compared. Results242 strains of pathogenic bacteria were isolated from airway secretion of VAP patients, 173(71.49%) were MDROs. The major pathogens causing VAP were Klebsiella spp. (n=66), Pseudomonas aeruginosa(n=64), Acinetobacter spp. (n=60), Staphylococcus aureus(n=27), and Escherichia coli (n=17), the percentages of MDROs of above pathogens were 68.18%, 50.00%, 91.67%, 88.89%, and 76.47% respectively. The prognosis of MDRO infection group was poorer than that of nonMDRO infection group, MDRA group had the worst prognosis(P<0.001). Persistent fever, leukocytosis, and progress of pulmonary inflammation in VAP patients suggested poor prognosis(all P<0.001);antimicrobial use in patients with effective therapy was higher than those in a worsened condition  before onset, at the beginning of onset, and after culture of specimens(all P<0.001), while coma, earlyonset VAP and multiple bacterial infection had no prognostic significance in patients with VAP(all P>0.05). ConclusionThere is high incidence of MDRO infection in patients with VAP, effective antimicrobial therapy can improve the prognosis.

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陈玉玲,孙思,左丽娜,等.多重耐药菌所致呼吸机相关肺炎的治疗及预后[J]. 中国感染控制杂志,2017,16(9):862-865. DOI:10.3969/j. issn.1671-9638.2017.09.018.
CHEN Yuling, SUN Si, ZUO Lina, et al. Therapy and prognosis of ventilatorassociated pneumonia caused by multidrugresistant organisms[J]. Chin J Infect Control, 2017,16(9):862-865. DOI:10.3969/j. issn.1671-9638.2017.09.018.

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  • 收稿日期:2016-07-27
  • 最后修改日期:2016-09-22
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  • 在线发布日期: 2017-09-13
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