The Analysis Of The Risk Factors And Pathogenic Characteristics Of Ventilator-associated Pneumonia In Intensive Care Unit

Objective:To analyze the risk factors and the pathogenic bacteria and drug resistance characteristics of ventilator-associated pneumonia(VAP)in patients with mechanical ventilation in the First People's Hospital of Guiyang,and to provide a certain basis for clinical science to effectively prevent the occurrence of VAP.It provides some reference for clinicians to rationally use antimicrobial agents,thereby reducing the incidence of VAP,reducing the emergence of drug-resistant strains,improving the therapeutic effect,and reducing the economic burden of patients.Methods:216 patients with mechanical ventilation longer than 48 hours hospitalized in intensive care unit of the First People's Hospital of Guiyang from March 2016 to September 2017 were selected.According to the clinical diagnostic criteria of VAP in the"Guidance for the diagnosis,prevention and treatment of ventilator-associated pneumonia 2013",these patients were divided into VAP group and non-VAP group,and clinical data,etiological results and drug susceptibility results were collected.The incidence of VAP was counted,the risk factors of VAP were analyzed,and the distribution characteristics and drug sensitivity of VAP pathogens were counted.SPSS19.0 statistical software was used for statistical analysis.The count data were expressed in terms of rate(%).The t-test was used to compare the measurement data between the two samples.Chi-square test was used to compare the count data between the two samples.The univariate analysis of the risk factors for ventilator-associated pneumonia was performed using the chi-square test.Multivariate analysis included the significant variables in the univariate analysis as a multivariate logistic regression analysis for statistical analysis.Results:1.Among 216 patients with mechanical ventilation>48 hours,55 patients developed VAP,and the incidence of VAP was25.5%.22 patients in VAP group died,and the mortality was 40.0%.37 patients in non-VAP group died,and the mortality was 23.0%.There was a significant difference in patient mortality between the two groups(c~2=5.981,P=0.014).2.Univariate analysis showed that age>60 years,serum albumin<30g/L,APACHE II>15,mechanical ventilation time>5 days,stress hyperglycemia,disturbance of consciousness,reintubation,using antacid agents,pulmonary disease,and antimicrobial agents used in the last two weeks were risk factors for VAP.Multivariate logistic regression analysis showed that age>60 years,mechanical ventilation time>5 days,APACHE II>15,serum albumin<30g/L,reintubation,combined lung disease,presence of disturbance of consciousness,appearance stress hyperglycemia were the independent risk factors for VAP.3.A total of 87 strains of pathogens were isolated from VAP group(55 case)and 68 strains of Gram-negative bacteria were found,accounting for 78.16%,of which Acinetobacter baumannii(23strains,26.44%).Pseudomonas aeruginosa(17 strains,19.54%)and Klebsiella pneumoniae(13 strains,14.94%)were the most common;There were 14 strains of gram-positive bacteria,accounting for 16.09%,which were common with staphylococcus aureus(8 strains,9.20%).Fungi was few,accounting for 5.75%.The top 5 pathogens were:Acinetobacter baumannii(26.44%),Pseudomonas aeruginosa(19.54%),Klebsiella pneumoniae(14.94%),Staphylococcus aureus(9.20%),Escherichia coli.(8.05%).4.Drug resistance of major gram-negative bacteria:the resistance rates of Acinetobacter baumannii to cefoperazone/sulbactam,amikacin,imipenem,and meropenem were 47.83%,52.17%,69.57%,73.91%respectively.The resistance rates of P.aeruginosa to meropenem,imipenem,amikacin,ciprofloxacin,and piperacillin/tazobactam were 29.41%,29.41%,29.41%,35.29%,41.18%respectively.The resistance rates of K.pneumoniae to meropenem,imipenem,amikacin,ciprofloxacin,piperacillin/tazobactam were:23.07%,30.76%,23.07%,30.76%,30.76%respectively.Conclusion:Age>60 years,mechanical ventilation time>5 days,APACHE II>15,serum albumin<30g/L,reintubation,combined lung disease,presence of disturbance of consciousness,appearance stress hyperglycemia were the risk factors for VAP;Gram negative bacteria are the main pathogens of VAP.Acinetobacter,Pseudomonas aeruginosa and Klebsiella pneumoniae are the main pathogenic bacteria of VAP.