| Objective:To explore the distribution of pathogenic bacteria and prognostic analysis of ventilator-associated pneumonia in intensive care units in Chongqing area, so as to provide reference for clinical prevention and treatment.Methods:A retrospective study was conducted in Chongqing three hospitals. The subjects were 962 patients consecutively admitted to the intensive care unit from January 2011 to October 2014. Collect the basic data of the patients who developed ventilator-associated pneumonia during the duration of the mechanical ventilation, including pathogenic bacteria, age, sex, smoking, onset of VAP, the frequency of intubation and invasion, tracheotomy, the sore of acute physiology and chronic health evaluation、 clinical pulmonary inflammation score、CHALSON complication index, prognosis and so on. First, take univariate analysis of factors associated with prognosis, if P<0.05, then take multivariate Logistic regression analysis.Results:Among the 962 mechanical ventilated patients,307 cases were firmly diagnosed as VAP. Among the patients, chronic obstructive pulmonary disease 112 cases、brain-injury disease or postoperation 102 cases、sepsis or shock 65 case、cardiopulmonary resuscitation 13 cases、 severe pancreatitis or gastrointestinal hemorrhage 8 cases、severe asthma 7 cases. The pathogenic bacteria isolated from sputum culture were 367 strains, Gram-negative bacteria (78.26%), followed by fungi (11.44%) and Gram-positive bacteria(10.30%). Among Gram-negative bacteria, the top 3 pathogens were acinetobacter baumannii, pseudomonas aeruginosa, and klebsiella pneumonia, respectively. Staphylococcus aureus was the main Gram-positive bacteria. There was an increase in fungal infection, mainly candida, followed by aspergillus. The factors associated with prognosis of ventilator-associated pneumonia included age, sex, APACHE Ⅱ, CPIS, CHALSON and tracheotomy. Pathogenic bacteria drug sensitive test showed that the multiple drug resistant strains (MDR) took the most part, accounting for 78.5%, sensitive strains 18.28%, pan drug resistant strains 3.22%. The relief rate of empiric antibiotic therapy in 72hours was 7.52%. More than 80% preferred choice was aminoglycoside, fluoroquinolone, carbon penicillin alkene alone or combined.In this report, the incidence of VAP was 31.91% and the mortality was 62.54%. The factors associated with outcome included age, smoking, APACHE II, CPIS, CHALSON and tracheotomy, especially APACHE II and CPIS made the most significant point. While sex, onset of VAP, frequency of intubation and invasion made no significant point in outcome of VAP.Underlying condition、immune、nutrition and infection severity were considered as the cause for high mortality and increasing fungi infection. Therefore, it was the key to take measures to adopt comprehensive therapy such as sensitive antibiotics、immune and nutrition improvement, strengthen hand hygiene and target monitoring and enhance prevention、early diagnosis and appropriate treatment, in order to decrease the incidence of VAP and improve the outcome.Conclusion:The incidence of VAP was 31.91% and the mortality was 62.54%. The pathogens distribution presented mainly multiple drug resistant gram-negative bacteria and an increase in fungi infection year by year. Drug-sensitive test mainly showed multiple drug resistant bacteria. The empirical antibiotic administration gained a low relief rate, therefore it was urgent to combine antibiotic use. The factors associated with outcome included age, smoking, APACHE II, CPIS, CHALSON and tracheotomy, which was closely related with underlying condition and severe infection. The prevention、early diagnosis and proper treatment of VAP should be enhanced in clinical practice. Meanwhile, it was the key to take measures to comprehensive therapy、strengthen hand hygiene and target monitoring and enhance prevention、early diagnosis and appropriate treatment to achieve the clinical prevention and treatment. |
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