Analysis Of Pathogens Distribution And Antibiotic Susceptibility For Ventilator-associated Pneumonia

Ventilator-associated pneumonia (VAP) in the intensive care unit (ICU) patientsreceiving mechanical ventilation is the most common acquired infections. Will not onlyincrease the incidence of VAP mortality, but also prolong hospitalization and increase thefinancial burden on patients. What is the current effective treatment of severe VAP hasbecome one of the issues of most concern in the medical field. Research has shown that a highdegree of suspicion for VAP in patients with early use of appropriate antibiotics cansignificantly reduce VAP mortality, so early empiric antibiotic selection for the treatment ofVAP is crucial, and early empiric antibiotic choice to be based IVAP pathogen distribution anddrug resistance, therefore monitoring in the ICU VAP pathogen distribution and drugresistance is very necessary. In the study, through specimens lower respiratory tract secretionsfrom VAP patients culture and sensitivity experiments to understand the distribution and drugresistance characteristics of VAP pathogens.0bjective To supply for treatment advice by investigating pathogens distribution andantibiotic susceptibility of ventilator-associated pneumonia(VAP) in the intensive careunit(ICU).Methodology In this study, a retrospective analysis of pathogen distribution andantibiotic susceptibility of VAP, selected the patients of VAP from the First Hospital of JilinUniversity ICU department in January2012to December2013period,a total of54cases, allpatients met the diagnostic criteria for VAP which the Critical Care Medicine Branch ofChinese Medical Association developed. While excluding incomplete data or death within72hours (including family members gave up treatment and deaths). All the patients useddisposable sterile suction tube or bronchoscopy to collect lower respiratory tract secretions.The secretions which collected used sterile disposable sputum collector to store and send tothe hospital laboratory within one hour, using a bacterial culture on MacConkey agar platesand incubated for72hours. The secretions used on MacConkey agar plates for bacterialculture, incubated for72hours.While excluded the same part of the same case fromspecimens collected repeated strains isolated.The positive results of bacterial culture usedVITEK2Compact to susceptibility test,the results accorded to the National Committee for Clinical Laboratory Standards(NCCLS) guidelines recommended by the results of thedetermination. In order to understand ventilator-associated pneumonia pathogen distributionand antibiotic sensitivity of pathogen,all of the clinical data which the patients with VAP,pathogens distribution and Antibiotic susceptibility used SPSS17.0software for twoindependent samples t-test statistical analysis.Results Totally143pathogens were isolated from deep-part secretion of lowerrespiratory tracts of54patients with VAP in ICU. Gram-negative bacteria(68.53%in all)wasthe main pathogen of VAP in ICU.It included15.58%of Pseudomonas aeruginosa,15.53%ofAcinetobacter baumanniii,11.89%of Maltophilia Aeromonas,10.48%of Klebsiellapneumoniae and7.69%of Escherichia coli.Gram-positive bacteria was19.58％,Staphylococcus aureus accounted for92.86%of the total Grand-positive bacteria and MRSAwas53.85%. Fungal was11.89%in all.The patients with VAP infected with Pseudomonasaeruginosa and other pathogens comparison showed that risk factors for duration ofmechanical ventilation, length of hospital stay before the diagnosis of VAP and diagnosis ofVAP before using the number of antibiotics had statistically difference. Acinetobacterbaumannii and other pathogens comparison showed that risk factors for duration ofmechanical ventilation, APACHE Ⅱ score, length of hospital stay before the diagnosis ofVAP and Bronchoscopic suctioning times had statistically differenc e. To pseudomonasaeruginosa, the drug resistance rate of ceftazidime, piperacillin and ampicillin/sulbactam allmore than50.0%. for imipenem and meropenem drug resistance rate were48.0%(17/25) and40.0%(10/25), gentamicin, amikacin, levofloxacin and ciprofloxacin had a low drugresistance rate, respectively,20.0%(5/25),28.0%(7/25),20.0%(5/25) and32.0%(8/25).Toacinetobacter baumannii, the drug resistance rate of ceftazidime, cefepime, gentamicin,piperacillin and piperacillin/tazobactam all more than60.0%, for imipenem and meropenemdrug resistance were45.45%(10/22) and52.94%（9/17）, minocycline had a low drugresistance rate as15.38%(2/13). To maltophilia Aeromonas, the drug resistance rate ofimipenem and meropenem was100.0%,for levofloxacin,minocycline and trimethoprim/sulfamethoxazole the drug resistance rate were11.76%(2/17),11.76%(2/17) and17.65%(3/17).To klebsiella pneumoniae and Escherichia coli, the drug resistance rate of ceftazidime,cefepime, cefotaxime all more than50.0%., klebsiella pneumoniae to levofloxacin andimipenem resistance rates were12.0%(5/25) and20.0%(5/25),escherichia coli to imipenem,meropenem and minocycline resistance rates were9.09%(2/22),11.76%(2/17) and7.69% (1/13). To MRSA, the drug resistance rate of erythromycin, penicillin, imipenem, gentamicin,tetracycline, clarithromycin, ciprofloxacin all more than85%, for rifampin and trimethoprim-sulfamethoxazole had a low drug resistance rate, respectively,21.43%(3/14),14.29%(2/14).MSSA only to penicillin resistance rates over90%.Conclusion Ventilator-associated pneumonia pathogens Gram-negative bacillusbacteria dominated, followed by Gram-positive bacteria, fungi least. Gram-negative bacteriafrom more to less proportions were Pseudomonas aeruginosa, Acinetobacter baumannii,Stenotrophomonas maltophilia bacteria, Klebsiella pneumoniae and Escherichia coli. In theGram-positive bacteria most of all were staphylococcus aureus. Patients with VAP, such aslong hospital stay, duration of mechanical ventilation and used a variety of antibiotics for along time, Gram-negative bacilli infections possibility of large, especially the infection ofpseudomonas aeruginosa and acinetobacter baumannii, which Apache II score high is morelikely the infection of Acinetobacter baumannii. The preferred treatment of pseudomonasaeruginosa infection carbapenems, followed by the choice of piperacillin/tazobactam.Treatment of Acinetobacter baumannii carbapenems as the drug of choice, but for multi-drugresistant strains should be combined minocycline anti-infective therapy. Treatment ofStenotrophomonas maltophilia infection levofloxacin, cotrimoxazole may be the drug ofchoice for highly resistant strains can be combined with minocycline treatment. Treatment ofStaphylococcus aureus infections vancomycin or linezolid as the preferred antibiotic.