| Objective To explore the characteristics and relationship of microbiology,isolated from adult patients in the intensive care unit(ICU)who underwent tracheal intubation or tracheotomy with ventilator associated pneumonia(VAP),and inflammation indicators,to provide some help for early diagnosis and treatment of VAP.Methods The clinical data of 78 adult patients,who were hospitalized in the ICU of the First Affiliated Hospital of Guangxi Medical University from January to June in 2018,with diagnosing VAP and isolating microorganisms,was collected.The general situation,microbiology and its drug resistance and inflammation indicators were analyzed retrospectively by using relevant statistical methods.Results 78 patients with VAP met the inclusion criteria with an average age of 58.5±16.273.The incidence rate was higher in men than in women(73.08%for men and 26.92%for women).Patients with VAP hada poor prognosis,especially with the following factors:age(?60 years),diabetes,cerebrovascular accident history,unconsciousness,and only 47.44%of patients could be discharged.The most common underlying diseases inVAP were pulmonary diseases,especially chronic obstructive pulmonary disease.It was followed by cardiovascular diseases,such as valvar heart disease and after the operation of cardiovascular disease.A total of 136 microorganisms were isolated,including87 Gram-negative(G~-)strains(63.9%),11 Gram-positive(G~+)strains(8.1%),and 38 fungi strains.(28.0%),whose isolation rate was higher in G~-bacteria(P<0.05).Among the top three G~-bacteria were Acinetobacter baumannii(48strains,35.5%),Pseudomonas aeruginosa(21 strains,15.4%)and Klebsiella pneumoniae(8 strains,5.9%).Staphylococcus aureus(8 strains,5.9%)was common in G~+bacteria,and Candida albicans in fungi(18.4%).There were 33cases(42.4%)with one microorganism(including 30.8%of G-bacteria),38cases(48.7%)with two microorganisms,mixing with G-bacteria and fungi(24.4%),and 7cases(8.9%)with three or more microorganisms.The proportion of multiple(two or more)microorganisms isolated from VAP patients was higher than that of one microorganism.It was a higher proportion of multiple(two or more)microorganisms than one microorganism.In this study,the incidence of multidrug resistant(MDR)in VAP patients was high.In particular,comparing with G~+bacteria,the G~-bacteria were more likely to be isolated with multidrug resistant organisms(MDRO)(P=0.025).Among them,the probability of MDR in Acinetobacter baumannii was the highest,mostly extensive drug resistance(XDR)and pan-drug resistance(PDR).Itmight be related to the history of antibiotics and repeated infections in the past 90 days(P<0.05).In addition,the body temperature,C reactive protein(CRP),and procalcitonin(PCT)were significantly higher after VAP occurs(P<0.05).Conclusions 1.The most common underlying diseases in VAP are pulmonary diseases and cardiovascular diseases,such as chronic obstructive pulmonary disease,valvar heart disease and after the operation of cardiovascular disease.2.Age(?60 years),combined with diabetes,history of cerebrovascular accident,and unconsciousness are common risk factors for poor prognosis of VAP.3.The microorganisms isolated from VAP patients are common with G~-bacteria and fungus,especially Acinetobacter baumannii and Pseudomonas aeruginosa.The chances of mixed infection of morethan two microorganisms are high.Patients with VAP have a high incidence of multi-drug resistance.Among them,the probability of XDR or PDRin Acinetobacter baumannii is the highest,which may be related to theusing of antibiotics and repeated infections in the past 90 days.4.The temperature and inflammation indicators,such as CRP,PCT,are increased afterthe occurrence of VAP,which may be related to the use of antibiotics and repeated infections in the past 90 days. |
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