呼吸机相关性肺炎的痰培养细菌分布和细菌耐药性分析

目的:探讨呼吸机相关性肺炎痰培养的泛耐药鲍曼不动杆菌的分布情况,分析泛耐药鲍曼不动杆菌的耐药性与危险因素。方法:选择2016年1月到2016年12月在我院进行机械通气的患者3826例作为研究对象,其中发生泛耐药鲍曼不动杆菌呼吸机相关性肺炎98例为观察组,同期按照2:1的比例选择非泛耐药鲍曼不动杆菌呼吸机相关性肺炎患者49例作为对照组,两组都进行细菌耐药性分析,同时调查患者的临床资料,分析呼吸机相关性肺炎患者中泛耐药鲍曼不动杆菌感染发生的危险因素。结果:观察组对于头孢噻肟、哌拉西林、亚胺培南、庆大霉素、左氧氟沙星、四环素、头孢他啶都高度耐药;除哌拉西林、多粘菌素外,对照组对抗菌药物的耐药率均明显低于观察组(P0.05)。单因素分析结果显示合并糖尿病、机械通气时间、APACHEⅡ评分、GCS评分、深静脉置管等因素与呼吸机相关性肺炎患者中泛耐药鲍曼不动杆菌感染显著相关(P0.05);非条件Logistic回归分析结果显示糖尿病、机械通气时间、APACHEⅡ评分、GCS评分导致呼吸机相关性肺炎患者中泛耐药鲍曼不动杆菌感染的独立危险因素(P0.05)。结论:呼吸机相关性肺炎患者中泛耐药鲍曼不动杆菌感染比较常见,对绝大多数抗菌药物有耐药性,糖尿病、机械通气时间、APACHEⅡ评分、GCS评分为主要的危险因素。

Bacterial Distribution and Antibiotic Resistance of Sputum Culture in Patients with Ventilator Associated Pneumonia

ABSTRACT Objective: To investigate the distribution of Pan drug resistant Acinetobacter baumannii in sputum culture of ventilator associated pneumonia and analyze the drug resistance and risk factors of Pan drug resistant Acinetobacter baumannii. Methods: From January 2016 to December 2016, 3826 cases of patients who were given mechanical ventilation in our hospital were selected as the re- search object, 98 cases with Pan drug resistant Acinetobacter Bauman ventilator-associated pneumonia were selected as the observation group, and the other 49 cases without Pan drug resistant Acinetobacter Bauman ventilator-associated pneumonia were selected as the control group, both groups were given bacteria analysis of drug resistance, and the clinical data were analyzed for investigating the risk factors. Results: High resistance to cefotaxime, piperacillin, imipenem, levofloxacin, gentamicin, tetracycline and ceftazidime were found in the observation group; in addition to piperacillin, polymyxin, the antimicrobial resistance rate in the control group were significantly lower than those in the observation group(P<0.05). The results of single factor analysis showed that diabetes mellitus, mechanical ventila- tion time, APACHE score, GCS score, deep venous catheterization were significantly to the ventilator-associated pneumonia in patients with Bauman pan resistant Acinetobacter(P<0.05). Conclusion: Diabetes mellitus, duration of mechanical ventilation, APACHE score, GCS score were independent risk factors for ventilator-associated pneumonia in patients with Pan drug resistant Acinetobacter baumannii.