| ObjectivesIn recent years, the number of ventilator patients was raised, with medical advances and the rapid development of mechanical ventilation, thus the incidence of ventilator-associated pneumonia (VAP) was also increased. Ventilator-associated pneumonia refers to the pneumonia occurred when established artificial airway (endotracheal intubation or tracheostomy) and used the mechanical ventilation for 48 hours, and disabling of mechanical ventilation or the removal of artificial airway within 48 hours. Some studies shown, our ventilator-associated pneumonia was 18% to 60% and mortality as high as 30% to 70%, foreign reports VAP incidence rate of 9% to 70% and mortality as high as 50% to 69%. VAP was becoming the main type of the hospital-acquired infections, was the common and serious complication of the mechanical ventilation, and was an important factor leading to sicker patients, the economic cost overruns, prolonged hospitalization and enlarged mortality. Spectrum of bacterial pathogens of VAP was affected by many factors, including patient age, underlying diseases, antibiotic duration, duration of mechanical ventilation, and etc. Drug resistance of pathogenic bacteria has also been undergoing change, with the widely use of antibiotics. With the increasing number of multi-resistant strains, the clinical application of antibiotics is facing a severe test. So the things of the accurate judgment for the resistance of pathogenic bacteria of VAP and the reasonable choice of antibiotics becomed more important in the treatment of VAP. The retrospective analysis were performed on the 371 cases of patients who were treated with mechanical ventilation, to explore the pathogen distribution and resistance changes in the Shandong Provincial Hospital intensive care unit, thus provide the theoretical basis for the reducing VAP and improving the prognosis of the patients, from January 2005 to December 2010.MethodsThe retrospective analysis were performed on the 371 cases of patients who were treated with mechanical ventilation from January 2006 to December 2011. They were grouped into two parts by with or without VAP. Then the VAP group were divided into two groups(group A, group B)according to the time of their onste. All specimens collected were taken to the principles of aseptic technique. We used the API system for bacteriological identification and susceptibility testing disk diffusion method, which reference to the United States CLSI 2000 revised standards. Diagnostic criteria was due to the "hospital-acquired pneumonia diagnosis and treatment guidelines" by the Chinese Society of Respiratory Diseases. Data are expressed as means±S.E.M and analyzed with use of SPSS 19.0 for Windows. Independent samples t test was used to compare continuous data for between-group differences. To evaluate the interactive effects of 2 factors, we used a 2-way anova.Two-tailed p<0.05 was considered statistically significant.ResultsThere was no significantly difference between the group A and B in the predisposing factor (X 2=0.19, P> 0.05). In the group A, the bacterium were found from the total 147 patients, from which 101 strains (about 68.43%)were gram negative bacilli(GNB),27 strains(about 18.37%) were gram positive gram positive coccus (GPC), and 19 strains(about 12.93%)were fungus. In the group B, the bacterium were found from the total 224 patients, from which 156 strains(about 69.86%)were gram negative bacilli(GNB),42 strains(about 18.77%) were gram positive coccus (GPC), and 26 strains(aboutll.37%)were fungus. There was no significantly difference between the group A and B in the Composition of pathogenic bacteria (X2=0.16, P>0.05). The antibiotics-sensitivity results showed that the rate of the VAP pathogens was increased, the multidrug resistant was enlarged, and the drug-resistant strains was increased significantly. And the drug resistance of many pathogens has shown some new changes.Conclusions1. The main VAP pathogenic bacterium in our hospital was gram negative bacilli. And the pseudomonasaeruginosa, acinetobacter baumannii, and xanthomonas maltophilia were the top three.2. The main VAP pathogenic bacterium of gram positive coccus was still staphylococcus aureus, and the rate of them was slightly increased.3. The main fungus was albicans Saccharomyces, and the rate of candida tropicalis was slightly increased.4. All the VAP pathogenic bacteria has shown the drug resistance. The multi-drug resistant pathogenic bacterium are also increasing. And the pseudomonasaeruginosa, acinetobacter baumannii, xanthomonas maltophilia, and Staphylococcus aureus were the most serious drug-resistant bacteria.5. So its very important to choose the antibiotics according to the results of the antibiotics sensitivity for the VAP treatment, to reduce and delay the emergence of resistant strains. |
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