Analysis On Risk Factors And Strategies Of Preventing And Treating For Hospital-acquired Pneumonia From A Neurosurgical Intensive Care Unit(NICU)

Although improving in treatment of antibiotics and measures of preventing and treating for Hospital—acquired pneumonia(HAP) recently ,the incidence of HAP is still very high. It is yet the chief reason resulting in the death , especially the patients in the NICU.To find out the risk factors of HAP,the analysis on the clinical materials from the NICU was made,so as to map out the effective measures of preventing and treating for HAP,to decrease the incidence of HAP and improving its treatment consequently .In order to know the risk factors of HAP,the clinical matericals of 721 patients in NICU of china-Japan Union Hospital of JiLin university from March ,2006 to March ,2008 were collected . By way of statistics and analysis on these materials , the relationship between HAP and a series of factors would be determined ,including the patients age,neurosurgical basic diseases,the length of hospitalization and NICU–staying.The patient`s consciousness during perioperative period,the lasting time of operations,the times of operations,the various invasive operations (intratracheal intubation and tracheotomy,central venous catheterization and transnasal gastro-intestinal nutrition infusion ) and the usage of antibiotics during perioperative period. Furthermore ,the infective bacteria would be divided according to appearing frenquency,to make out the epidemiologic trend of the pathogens . Last, the results of susceptibility test to the antibiotics about pathogens were summed up, so that the antibioties were used properly.One hundred and eighty-nine patients were diagnosed as the HAP in 721 cases, by the US guidelines for the management of Hosptial-acquired pneumonia in 2005.Its incidence is 26.21%(189/721).The difference of HAP incidence existed evidently between the various neurosurgical lesions (p < 0.001).The incidence was respectively as follows: hypertensive cerebral hemorrhage 40.37%,craniocerebral injury 37.5%,intracranial aneurysm 32.76%,intracranial tumor 7.14% and others 8.54% . The statistical difference about incidence of HAP developed among the different age groups (p=0.0031);the elder the age, the higher the incidence of HAP(p< 0.001).The consciousness level of the patients during the perioperative period was closely related to the incidence of HAP(p< 0.001);the disturbance of consciousness raised the HAP incidence(p< 0.001). The average days of hospitalization and NICU-staying were longer in HAP group than non-HAP group (p< 0.001).The operative lasting and times had also intimate relation to HAP;the average operative time was longer in HAP group (p=0.0066) ; the operations more than four hours increased the HAP opportunity apparently(P < 0.0015); fourthermore , the possibility of HAP went up along with the operative times (P <0.001).The various invasive operations also increased the incidence of HAP , as intratracheal intubation,tracheotomy,central venous catheterization and transnasal gastro-intestinal nutriton infusion (p< 0.001). All the same, the HAP came into existence easily during using the corticosteriod and H2-receptor blocking agents (p <0.0001 and p< 0.001).About the pathogens culture, 73 cases in 98 patients had positive results. The positive rate is 78.4%(73/98) .The major pathogens of HAP were Gram-negative bacilli . The susceptive antibiotics to these bacteria were carbapenems,piperacillin/tazobactam,amikacin and ceftazidime. The chief Gram–positive cocci that caused the HAP was staphylococcus aureus and the susceptive antimicrobials included vancomycin,teicoplanin,sulphonamides and rifampicin.There were many factors closely related to the HAP,including : the patient`s age,neurosurgical basic diseases,the length of hospitalization and NICU staying,the patient`s consciousness level during perioperative period,the operative lasting,the time of operations,the various invasive operations(intratracheal intubation and tracheotomy,central venous catheterization,transnasal gastrointestinal nutrition infusion) and using the corticosteriod and H2-recepto blocking agents. The incidence of HAP had no relation to the prophylactic usage of the antibiotics .The preventing development of the HAP played an important and cracial role in improving the patients prognosis. The specific strategies should be worked out by focusing on the pathophysiological mechanism,spreading approaches and risk factors of HAP, including : improving the environment of NICU,enforcing the aseptic and sterilizing system strictly,effectively preventing the patient`s misinhaling and helping the patients to eliminate the secretion in the respiratory tract,avoiding inappropriate use of corticosteriod and H2-receptor blocking agents,reduding the various invasive operations if possible ,and so on.The diagnosis of HAP includs whether the patients were coming down with pneumonia or not and its pathogens . The patients are treated with antibiotics experientially as soon as the clinical diagnosis is determined, according to the epidemoilogic trend of the recent pathogens and results of susceptibility test .After that , the materials of pathogens should be obtained as fast as possible and the target treatment starts with the susceptible antibiotics at once.In a word , by means of the better preventing measures timely and correct diagnosis and the appropriate treatment , the incidence and morbidity of HAP would be reduced remarkably.