ICU呼吸机相关性肺炎病原菌分布情况及多重耐药菌感染的危险因素调查研究

doi:10.3969/j.issn.1006-6233.2022.07.023

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Abstract Objective: To investigate the distribution of pathogenic bacteria and risk factors of multidrug-resistant bacteria infection in patients with ventilator-associated pneumonia in ICU. Methods: Clinical data of 150 patients with ventilator-associated pneumonia admitted to our hospital from January 2018 to December 2020 were retrospectively collected, and the distribution of pathogenic bacteria in patients was analyzed. Patients were divided into the drug-resistant bacteria group (93 cases) and the non-drug-resistant bacteria group (57 cases) according to whether multidrug-resistant bacteria infection occurred. The single factor of multidrug-resistant bacteria infection in patients with ventilator-associated pneumonia ICU was analyzed, and the risk factors of multiple drug-resistant bacteria infection in patients with ventilator-associated pneumonia in ICU were analyzed by multivariate Logistic regression. Results: A total of 240 strains of pathogenic bacteria were isolated from 150 patients with ventilator-associated pneumonia in ICU, mainly gram-negative bacteria, accounting for 84.17%, among which the top three pathogens were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa (25.42%, 20.42%, 12.50%). A total of 93 cases of multidrug-resistant bacteria infection occurred in 150 patients with ventilator-associated pneumonia in ICU, and the infection rate was 62.00%. Univariate analysis showed that the proportion of patients with diabetes mellitus, disturbance of consciousness, dysphagia, late type of stroke associated pneumonia, the treatment of the 3rd and 4th generation cephalosporins as well as complex preparations containing enzyme inhibitors and carbapenems in the past 90 days, time of ventilator ventilation ≥7 d, ICU stay ≥7 d in the drug-resistant bacteria group was higher than that in the non-drug-resistant bacteria group (P<0.05). Multivariate Logistic regression analysis showed that the disturbance of consciousness, late type of stroke associated pneumonia, the treatment of the 3rd and 4th generation cephalosporins as well as complex preparations containing enzyme inhibitors and carbapenems in the past 90 days, time of ventilator ventilation ≥7 d, ICU stay ≥7 d were all independent risk factors for multidrug-resistant bacteria infection in patients with ventilator-associated pneumonia in ICU (OR=4.644, 3.152, 4.289, 2.421, 17.167, P<0.05). Conclusion: The main pathogen of ventilator-associated pneumonia in ICU was Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa, patients with ventilator-associated pneumonia in ICU correlation independent risk factors for infection multi-resistant bacteria including the occurrence of disturbance of consciousness, late onset of ventilator-associated pneumonia, indent gastric tube, time of ventilator ventilation ≥7 d, and ICU stay ≥7 d. Clinically, targeted intervention or treatment could be carried out for patients with the above characteristics to reduce the risk of multidrug-resistant bacteria infection in patients with ventilator-associated pneumonia in ICU.

Key words： Ventilator-associated pneumonia Multidrug-resistant bacteria Infection Intensive care unit Pathogenic bacteria Risk factors

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2022.07.023 OR http://www.hbyxzzs.cn/EN/Y2022/V28/I7/1166

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