摘要
目的:分析呼吸机相关性肺炎(ventilator associated pneumonia,VAP)患者的肺部病原菌分布情况,并探讨VAP发病的影响因素。方法:采用回顾性研究方法,选取2018年1月至2021年12月在山西医科大学第一医院及阳泉市第一人民医院接受机械通气治疗的1164例患者作为研究对象,均留取痰标本进行病原菌检测。收集研究对象一般资料(年龄、性别、住院时间、手术情况)、机械通气时长及次数、尿管和中心静脉导管留置时长及次数、抗菌药物使用时长及次数、痰标本的病原菌情况等信息。分析VAP患者肺部病原菌分布特点,并应用多因素logistic回归模型探究研究对象发生VAP的影响因素。结果:1164例研究对象中,171例(14.69%)发生VAP。171例VAP患者下呼吸道分泌物或气管插管终端分泌物中共检出378株病原菌,其中,革兰阴性菌298株(78.84%),革兰阳性菌66株(17.46%),真菌14株(3.70%);肺炎克雷伯菌、鲍曼不动杆菌是主要病原菌,分别占23.81%(90/378)、14.81%(56/378)。多因素logistic回归分析显示,手术[OR(95%CI)=2.506(1.640~3.828)]、住院时间≥14 d[OR(95%CI)=2.749(8.424~28.968)],以及留置尿管[OR(95%CI)=14.208(5.285~38.192)]均是接受通气治疗患者发生VAP的独立影响因素。结论:条件致病菌是造成机械通气治疗患者呼吸道感染的主要致病菌;对于实施手术、住院时间较长,以及留置尿管的患者,要警惕其发生VAP的风险。
Objective:This study aims to elucidate the distribution of pulmonary pathogens in patients suffering from ventilator-associated pneumonia(VAP)and to investigate the factors influencing the incidence of VAP.Methods:Employing a retrospective research approach,this study involved 1164 patients who underwent mechanical ventilation at the First Hospital of Shanxi Medical University and the First People’s Hospital of Yangquan City from January 2018 to December 2021.Sputum samples were collected from each patient for pathogen detection.We gathered comprehensive demographic and clinical data,including age,gender,length of hospital stay,and surgical history.Additionally,detailed records of mechanical ventilation and the duration and frequency of indwelling urinary and central venous catheters,as well as antibiotic usage,were maintained.The study aimed to characterize the distribution of pulmonary pathogens in VAP patients and utilized a multivariate logistic regression model to identify and analyze the factors influencing the incidence of VAP among the subjects.Results:Among the 1164 participants enrolled in this study,171 cases(14.69%)developed VAP.Analysis revealed a total of 378 pathogenic strains isolated from the lower respiratory tract or tracheal intubation terminal secretions of these patients.Of these,298 strains were Gram-negative bacteria(78.84%),66 were Gram-positive bacteria(17.46%),and 14 were fungal strains(3.70%).Predominant pathogens included Klebsiella pneumoniae and Acinetobacter baumannii,constituting 23.81%(90/378)and 14.81%(56/378)of the isolates,respectively.Multivariate logistic regression analysis identified surgical interventions(OR=2.506,95%CI=1.640-3.828),prolonged hospital stays of 14 days or more(OR=2.749,95%CI=8.424-28.968),and the use of indwelling catheters(OR=14.208,95%CI=5.285-38.192)as independent risk factors significantly associated with the occurrence of VAP in mechanically ventilated patients.Conclusion:Conditional pathogens predominantly contribute to respiratory infections in pa
作者
赵瑞娜
李淑花
崔晓红
弓巧巧
裴俊丽
袁丽荣
Zhao Ruina;Li Shuhua;Cui Xiaohong;Gong Qiaoqiao;Pei Junli;Yuan Lirong(Department of Pulmonary and Critical Care Medicine,The First Hospital of Shanxi Medical University,Taiyuan 030001,China)
出处
《结核与肺部疾病杂志》
2024年第4期305-310,共6页
Journal of Tuberculosis and Lung Disease
关键词
通气机
机械
感染
肺炎
呼吸机相关性
因素分析
统计学
Ventilators,mechanical
Infection
Pneumonia,ventilator-associated
Factor analysis,statistical
