The Epidemiological Investigation Of Ventilator-associated Tracheobronchitis

Objective: Through the surveys of occurrence rate and etiological study of ventilator-associated tracheobronchitis(VAT),to explore the influence of VAT on prognosis and the role of antibiotics in progression from VAT to ventilator-associated pneumonia(VAP),so as to provide guidance for preventing the ventilator-associated respiratory infection,reducing the mechanical ventilation time and hospitalization time of patients.Methods: By Adopting the method of retrospective study,we investigated patients with the mouth(nose)endotracheal intubation or tracheotomy,mechanical ventilation time>48h,and no lung disease in intensive care unit(ICU)of Cangzhou people's hospital from Jan 2012 to Dec 2015.According to the diagnosis standard of VAT and VAP,we divided the patients into the VAT,VAP and uninfected group.And then comparing their age,sex,underlying disease,admitting diagnosis,APACHE ?score,mechanical ventilation time,ICU treatment time,hospitalization time and mortality.According to whether VAT progress to VAP,it's divided into the subsequent VAP group and no subsequent VAP group.Then comparing the age,sex,underlying disease,admitting diagnosis,APACHE ?score,microbial results,antibiotics,nasogastric feeding,oral care,mechanical ventilation time,ICU treatment time,hospitalization time and mortality.Results: 752 patients were included in this study,which were divided into the VAT group(87 cases),the VAP group(90 cases)and uninfected group(575 cases).The morbidity of VAT and VAP are 11.57% and 11.97%.There is no statistically significant difference on age,sex,underlying disease and admitting diagnosis(P>0.05).The APACHE scores of VAP are ?significantly higher than VAT and uninfected group(P<0.01).The mechanical ventilation time,ICU treatment time,hospitalization time of VAT group and VAP group are obviously longer than uninfected group(P<0.01).The mortality rate of VAP(23.33%)group is apparently higher than VAT group(12.64%)and uninfected group(12.35%),the difference is statistically significant(P<0.05).39 cases(44.83%)of 87 developed into VAP(subsequent VAP group).48 cases didn't(No subsequent VAP group).There was no statistically significant difference on baseline comparison of the two groups(P>0.05).In subsequent VAP group,the patients used compound gargle solution chlorhexidine giuconatie for oral care are less than no subsequent VAP group(P<0.05).The patients with nasal feeding are more than no subsequent VAP group,the difference is statistically significant.(P<0.05)103 strains of bacteria have been detected from the VAT group.The top five are pseudomonas aeruginosa(22.33%),acinetobacter baumannii(19.41%),escherichia coli(17.48%),meticillin-sensitive staphylococcus aureus(MSSA,11.65%),Klebsiella pneumoniae(10.68%)and multidrug-resistant isolates(MDR)of the VAT group is 53.40%.There was no statistically significant difference on microorganism of subsequent VAP group and no subsequent VAP group(P>0.05).The MDR in subsequent VAP group are more than no subsequent VAP group(58.70% vs.49.12%),but there is no statistical difference(P>0.05).More patients received appropriate antibiotic treatment in no subsequent VAP group is more than subsequent VAP group(79.17% vs.43.59%),the difference is statistically significant(P<0.05).The mechanical ventilation time,ICU treatment time,hospitalization time of subsequent VAP group are longer than no subsequent VAP group(P<0.01).The mortality rate is higher than no subsequent VAP group,but there is no statistical difference(P>0.05).Conclusions:1 The morbidity of VAT in our hospital was 11.57%,44.83% of them progressed to VAP.2 The top five bacteria of the VAT group are pseudomonas aeruginosa,acinetobacter baumannii,Escherichia coli,meticillin-sensitive Staphylococcus aureus(MSSA),and Klebsiella pneumoniae,and multidrug-resistant isolates(MDR)of the VAT group is 53.40%.3 VAT can also increase the mechanical ventilation time,ICU treatment time,and hospitalization time of patients as VAP.4 Appropriate antibiotic treatment can reduce the progress VAT to VAP.5 The higher the APACHE?score,the more ventilator-associated lower respiratory infection.Using compound gargle solution chlorhexidine giuconatie can prevent the happening of VAT.Nasogastric feeding can increase the risk of probability about VAT.