The Analysis Of The Risk Factors, Pathogen Characteristics And Antimicrobial Resistance Of Ventilator-Associated Pneumonia

Objective:To explore the risk factors, pathogen characteristics and antimicrobial resistance of ventilator-associated pneumonia (VAP) patients undergoing mechanical ventilation in respiratory intensive care unit (RICU) of the Hospital of Guizhou Provincial People's Hospital and provide the effective treatment and rational use of antibiotics to reduce the incidence of antimicrobial resistance rates in VAP patients.Methods: ? The clinical data of 169 in RICU patients who underwent more than 48 hours of mechanical ventilation in Guizhou Provincial People's Hospital from November 2012 to November 2015 were collected. The patients with VAP were considered as the VAP group, and the patients without VAP were considered as the non-VAP group.? The clinical data of VAP group and non-VAP group of general information, clinical data, etiological characteristics and antimicrobial resistance were analyzed. The data was performed using SPSS 17.0 software. The count data was compared by chi-square test or corrected chi-square test. The regression equation through non-conditional Logistic regression analysis was established as Logistic P=-5.281+0.363X1+0.865X2+0.782X3+ 1.286X4+1.843X5+1.139X6, where representative of age X1?X2 behalf of the APACHE ? score, X3 behalf of the time of MV, X4 behalf of combination therapy with more than two types of antibiotics, X5 behalf of hypoproteinemia, X6 behalf of the coma. The non-conditional Logistic regression analysis being used in screening out the independent risk factors of VAP from the statistically significant factors in a Single factor analysis.Results:?There were patients after VAP patients were 56 (31 for male and 25 for female) among 169 patients with more than 48h mechanical ventilation. The occurrence and the mortality of VAP was 33.14% and 37.50%, respectively. Non-VAP patients were 113 (71 for male and 42 for female) and the mortality was 15.9%.?Single factor analysis showed that patients older than 60 years, length of mechanical ventilation equal to or more than 5 days, hypoproteinemia (equal to or less than 28g/L), APACHE ? score greater than or equal to 20, coma, tracheostomy and combination therapy with more than two types of antibiotics) were related to the occurrence of VAP (P?0.05). The OR values of age, length of mechanical ventilation, hypoproteinemia, APACHE ? score, coma and combination therapy with more than two types of antibiotics was 1.44,2.20,4.32,2.48,3.20 and 3.62 respectively. ?A total of 96 strains of pathogens were isolated from VAP group. The top five pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumonia, Staphylococcus aureus, Candida albicans. The strains of gram-negative bacteria, gram-positive bacteria and fungi was 68(70.83%) 17(17.71%) and 11(11.46%), respectively. The Acinetobacter baumannii (22strains,22.92%) was predominant in gram-negative bacteria, followed by Pseudomonas aeruginosa(20strains,20.83%), accounted for third Klebsiella pneumoniae (12strains,12.5%). The Staphylococcus aureus(11strains) was dominant among the gram-positive bacteria and the Candida albicans (6 strains) was the main pathogens in fungi.?The resistance rate of Acinetobacter baumannii to meropenem was 40.91%. The resistant rate of Acinetobacter baumannii to imipenem, amikacin, polymyxin and minocycline were 36.36%,36.60%, 9.09% and 27.27% respectively. The resistant rate of Pseudomonas aeruginosa to cefoperazone sulbactam, piperacillin tazobactam and carbapenem (meropenem, imipenem) was 25%. The resistant rate of Pseudomonas aeruginosa to amikacin, ciprofloxacin and polymyxin was 30%,35% and 10%, respectively. The resistance rate of Enterobacteriaceae to imipenem, meropenem, piperacillin/tazobactam was lower than 25%. Staphylococcus aureus had high sensitivity to glycopeptides (100%) and polymyxin(90.91%).Conclusion: ? The mortality rate of VAP patients in RICU was greater than that of non VAP patients.? The patients older than 60 years, length of mechanical ventilation equal to or more than 5 days, hypoproteinemia (equal to or less than 28g/L), APACHE ? score greater than or equal to 20, coma, combination therapy with more than two types of antibiotics were closely related to VAP, which were the independent risk factors for VAP. ? The gram-negative bacteria are the mainly pathogens from VAP in RICU, followed by gram-positive and fungi. The Acinetobacter baumannii was the dominant pathogens among gram-negative bacteria, followed by Pseudomonas aeruginosa and Klebsiella pneumonia. Gram-negative bacteria have high drug resistance to antibiotics.The gram-positive bacteria are the mainly pathogens Staphylococcus aureus. The fungi are the mainly pathogens Staphylococcus aureus.?The VAP pathogens in RICU the top five pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumonia, Staphylococcus aureus, Candida albicans.?Carbapenem (meropenem, imipenem) or amikacin is the first choice for VAP in RICU with Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae Glycopeptides (vancomycin, linezolid and teicoplanin) and Polymyxin are the first choice for MRSA infection.