Analysis Of Risk Factors And Drug Resistanace Of Pathogenic Bacteria In Patients With Ventilator-associated Pneumonia

Objective :To investigate the clinical characteristic of inpatients with ventilator-associated pneumonia(VAP)in intensive care unit(ICU)in Qionglai City Medical Center Hospital,drug resistance of pathogenic bacteria,risk factors to VAP,and to provide scientific basis to prevent and individualizedly treat VAP in clinic.Methods:A total of 472 patients with ICU admitted to Qionglai City Medical Center Hospital in January 2015 to October 2016 were included in this study.Years old,gender,the score of APACHE II,consciousness condition,microorgnism cononization in the oropharynx,microorgnism cononization in the gastric juice,microorgnism cononization in the heater humidifier,microorgnism cononization in the condensing apparatus,microorgnism cononization in the screwed pipe,treatment with H2 receptor blocker,the last time and mode mechanical ventilator and condition of VAP were collected.The risk factors of VAP were analyzed by single-factor analysis and Logistic regression analysis.Sputum smear was produced after the secreta in the lower respiratory tract were taken by sterile sputum suction-pipe.If the result of microscopic examination was OK,the bacteria of the secreta in the lower respiratory tract was cultured.All bacterial strains were identified by VITEK automatic microorganisms analyzer.Drug sensitive test of main isolated bacterial strains to common antibiotics was conducted by K-B method,and the results were judged by criterion of clinical and Laboratory Standards Institute(CLSI)of version 2014.Results:(1)There were 184 patients with VAP in this group of 472 patients,and the incidence rate of VAP was 38.98%.(2)The results of single-factor analysis showed that years old,the score of APACHEII,consciousness condition,microorgnism cononization in the oropharynx,microorgnism cononization in the heater humidifier,microorgnism cononization in the condensing apparatus,microorgnism cononization in the screwed pipe,the last time and mode mechanical ventilator were related to occurence of VAP(P<0.05),but gender,microorgnism cononization in the gastric juice,treatment with H2 receptor blocker were not related to occurence of VAP(P>0.05).(3)The results of Logistic regression analysis showed that years old,the score of APACHEII,microorgnism cononization in the heater humidifier,and the last time and mode mechanical ventilator were related to occurence of VAP(P<0.05).(4)A total of 141 bacterial strains were isolated from the inspect samples.There were 21(14.89%)strains of gram-positive bacteria,101(71.63%)strains of gram-negative bacteria,and 19(13.48%)stains of fungus.(5)In isolated bacterial strains,there were 34(23.94%)strains of Acinetobacter baumannii with highest proportion,consecutively,there were 28(19.86%)strains of Klebsiella Klebsiella pneumoniae,17(12.06%)strains of candida albicans,16(11.35%)strains of pseudomonas aeruginosa and 11(7.80%)strains of staphylococcus aureus.(6)Acinetobacter baumannii had high drug resistance rate to sulbactam,imipenem,penicillin and cephalosporin,but had low drug resistance rate to trimethoprim/sulfamethoxazole.(7)klebsiella pneumoniae had 100% drug resistance rate to cefradine,amoxicillin and ampicillin,was sensitive to ceftazidime and piperacillin,had low drug resistance rate to imipenem,aztreonam and levofloxacin,but had high drug resistance rate to cephalosporin antibiotics.(8)Pseudomonas aeruginosa was sensitive to gentamicin and tobramycin,and had low drug resistance rate to imipenem,levofloxacin and ciprofloxacin,and had high drug resistance rate to most cephalosporin antibiotic.(9)Staphylococcus aureus had low dug resistance rate to the comman antibiotics except amoxicillin,and did have drug resistance to nitrofurantoin,gentamicin and sulfamethoxazole.(10)Escherichia coli had high drug risistance to many antibiotics,and almost resistance to penicillins,cephalosporins and quinolones,had low drug resistance to piperacillin/tazobactam and was sensitive to imipenem.Conclusion:(1)The problem of infection in ICU in Qionglai City Medical Center Hospital is increasingly seriously.(2)Years old,the score of APACHEII,microorgnism cononization in the heater humidifier,and the last time and mode mechanical ventilator were related to occurence of VAP.(3)Gram-negative bacteria are the main pathogenic bacteria of VAP,and some baeteria are multiple drug-resistant.