Analysis Of Risk Factors And Etiology Of Ventilator-associated Pneumonia

Objective:To analysis the risk factors and the distribution and antimicrobial resistance of bacteria of ventilator-associated pneumonia (VAP), in order to provide evidence for prevention and therapy of VAP. Methods:(1) Retrospective analysis was performed on the clinical date in 97 patients who had received mechanical ventilation from Jan 2009 to Dec 2009 of the First Hospital Attached to Xinjiang Medical University (including age, gender, underlying disease, clinical diagnosis, duration of hospitalization, artificial airway or mechanical ventilation, acids usage, corticosteroid usage, et al; (2) Collect respiratory tract secretion to culture and analysis the susceptibility of antimicrobials, identify the etiology and resistance of VAP; (3) The cases were divided into the VAP group and Non-VAP group. Univariate chi-square was conducted and then Non-condition Logistic regression analysis of the markedly different factors in the two groups was employed in SPSS 17.0. Results:(1) Totally 97 patients were enrolled in this study, of which 46 were diagnosed as VAP. The morbidity of VAP was 47.4%. The mortality was 27.8%; (2) Single factor analysis showed that 8 factors (such as age, underlying disease, duration of MV, acids usage, corticosteroid usage, et al were related to the occurrence of VAP. Multi-variable logistic analysis identified smoking, the way of MV, acids usage and sedative as the 4 independent risk factors of VAP; (3) A total of 153 pathogenic bacteria were identified. Among all the strain casing VAP, gram-negative bacteria accounted for 77.5%, in which acinetobacter baumannii was the major pathogen. Gram-positive cocci occuping 12.4%and 11.1%were fungi. Conclusion:(1) VAP was related with a variety of factors; (2) Gram-negative bacteria were the most common pathogens of VAP, which presented to multi-drug resistant pattern, gram-positive cocci and fungi accounted for a certain proportion. Clinician should choose antimicrobial agents according to antimicrobial susceptibility test result in time; (3) Actively control the risk factors of VAP, the use of bundle therapy to prevent the morbidity and mortality of VAP, reduce hospital stay and medical expenses, will have a significant value.