The Analysis Of The Risk Factors And The Etiological Characteristics Of The Ventilator-associated Pneumonia Disease In Respiratory Intensive Care Unit

objectiveTo explore the risk factors, pathogen distribution and drug resistance in thepathogenesis of ventilator-associated pneumonia (VAP) in respiratory intensive careunit (RICU), providing some clinical evidences for more scientific and effectivetreatment of ventilator-associated pneumonia.methods165patients underwent more than48hours of mechanical ventilation in ICU ofRespiratory Medicine of the Fifth Affiliated Hospital of Zhengzhou University fromJanuary2011to April2013were enrolled. The patients with VAP were considered asthe case group (n=59), and the patients without VAP were considered as the controlgroup (n=106). The clinical data were retrospectively analyzed, including the patient’sage, serum albumin, acute physiology score (APS), the duration of mechanicalventilation, state of consciousness, with or without chronic bronchial-pulmonarydisease, with or without using antacids and treatment outcome. The t test and χ2testwere used for univariate analysis of the quantitative and qualitative data, respectively.The non-conditional Logistic regression analysis was used for screening out the risk factors of VAP from the statistically significant factors in univariate analysis. Thecollected lower respiratory tract secretions were cultured in the plate with the serialtwo-fold dilution method. The drug susceptibility test was conducted by using K-Bmethod. The microbiological data were collected from the case group for analysis ofthe distribution and drug resistance of VAP pathogens.results1. The attack rate of VAP in RICU was35.8%. Among59patients in the casegroup, there were25cases of death, with a mortality rate of42.4%. Among106patients in the control group, there were28cases of death, with a mortality rate of26.4%.2. Multi-factor Logistic regression analysis showed that age, decreased serumalbumin, chronic bronchial-pulmonary disease, the duration of mechanical ventilationand APS score were risk factors of ventilator-associated pneumonia, with the ORvalues of1.902,0.300,2.211,1.856and1.737, respectively.3. A total of80strains of pathogens were cultured from the lower respiratorytract secretions in the case group, including57strains (71.25%) of gram-negativebacilli,13strains (16.25%) of gram-positive cocci and10strains (12.50%) of fungi.The top eight pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa,Staphylococcus aureus, Klebsiella pneumoniae, Candida albicans, Stenotrophomonasmaltophilia, Escherichia coli in sequence. Multidrug-resistant pathogens were morecommon in pathogens, including methicillin-resistant Staphylococcus aureus (MRSA),carbapenems-resistant Acinetobacter baumannii, multidrug-resistant/pan-resistantPseudomonas aeruginosa, carbapenemases-producing Enterobacteriaceae bacteria andextended-spectrum β-lactamase (ESBLs)-producing bacteria. Acinetobacterbaumannii and Pseudomonas aeruginosa had lower resistances to carbapenems andβ-lactam/β-lactam enzyme inhibitor compound preparations. MRSA accounts for ahigher proportion and was sensitive to vancomycin bacteria. conclusion1. The occurrence of VAP is related to multiple risk factors. Age, decreasedblood albumin, chronic bronchial-pulmonary disease, the duration of mechanicalventilation and APS score are risk factors of the pathogenesis of ventilator-associatedpneumonia.2. The VAP pathogens in RICU of the Fifth Affiliated Hospital of ZhengzhouUniversity are mainly in gram-negative bacilli, followed by gram-positive cocci andfungi. The multidrug-resistant bacteria account for a high proportion of pathogenicbacteria. There is a relatively serious problem of drug resistance.