| Objective: To analyze the risk factors and etiological characteristics of ventilator-associated pneumonia (VAP) in intensive care unit, in order to provide a clinical basis for developing positive and effective prevention and therapy of VAP.Methods: A retrospective study were used. We selected 138 cases for the survey from intensive care unit(ICU) of Traditional Chinese Medicine Hospital of Zhangjiagang and the First Hospital of Zhangjiagang from December 2009 to May 2011. All patients underwent endotracheal intubation and mechanical ventilation. Patients with VAP group were set for the case group, 33 cases were chosen from Traditional Chinese Medicine Hospital of Zhangjiagang, and 35 cases were chosen from the First Hospital of Zhangjiagang; the remaining 70 patients without VAP were chose as control group, 32 cases from Traditional Chinese Medicine Hospital of Zhangjiagang, 38 cases from the First Hospital of Zhangjiagang. The surveys were followed up until the withdrawal of ICU. The following parameters and data collection were: patient's age, weight, nutritional status, underlying diseases, APACHE II score, state of consciousness, using gastric acid-suppressing agents or not, the time of mechanical ventilation. Bacterial etiology check:①Plate dilution method using isolated pathogens in lower respiratory tract secretions, analyze its composition ratio. It is considered clinically significant, if the two consecutive trains are the same.②The use of K-B method for drug susceptibility testing to study its sensitivity to antimicrobial drugs situation. Multiple samples were compared by F test, mean pairwise comparison between the methods were compared using LSD, count data were compared with the test analysis, the sample rate of pairwise comparison between the segmentation using the chi-square analysis, using non- Logistic regression model for univariate analysis, factors that are statistically significant risk factors for VAP, use BACK LR method to gradually control for confounding factors, the establishment of the regression equation. Test level for the P = 0.05.Results: (1) 27 cases in 68 patients of the case group were dead, the mortality was 39.7%; 9 patients in 70 patients of the control group died, the mortality rate was 12.9%; Acquiring lower respiratory tract secretions from VAP group to develop the pathogen, 97 bacteria were cultured, including 79 strains gram-negative bacteria (G-)(81.4%), the priority was Pseudomonas aeruginosa, followed by Acinetobacter baumannii and Klebsiella pneumoniae. There were 18 strains of Gram positive bacteria (G+)(18.6%), the priority was Staphylococcus aureus. Logistic regression analysis showed that: age≥60 years, the use of acid-suppressing drugs, APACHEII score≥15, duration of mechanical ventilation≥5 days, the primary disease being chronic obstructive pulmonary disease as the impact of VAP factors. Susceptibility test results showed that: Pseudomonas aeruginosa to ceftazidime, cefoperazone / sulbactam, piperacillin / tazobactam, carbapenems is more sensitive, and Acinetobacter baumannii to carbapenems , cefoperazone / sulbactam and piperacillin / tazobactam is more sensitive, while Staphylococcus aureus is susceptible to vancomycin absolutely.Conclusion: The main pathogens of VAP in ICU are the G-bacteria, including Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae, in the two main hospitals in Zhangjiagang region. G+ bacteria are Staphylococcus aureus mainly. As the major pathogens of VAP, Pseudomonas aeruginosa to ceftazidime, cefoperazone / sulbactam, piperacillin / tazobactam, carbapenems is more sensitive, and Acinetobacter baumannii to carbapenems , cefoperazone / sulbactam and piperacillin / tazobactam is more sensitive, while Staphylococcus aureus is susceptible to vancomycin absolutely. Age≥60 years, the use of acid-suppressing drugs, APACHE II score≥15, duration of mechanical ventilation≥5 days, and the primary disease being chronic obstructive pulmonary disease are the risk factors of VAP. |
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