| BackgroundVentilator associated pneumonia(VAP)is the most common acquired pneumonia in hospitals.It refers to pneumonia occurs between 48 hours after mechanical ventilation(MV)and 48 hours after extubation in patients without pulmonary infection.The main pathogens were bacteria,followed by fungi or viruses.The incidence of VAP in general departments is generally maintained at 9%-24%and the fatality rate is 20%-71%.The incidence of VAP in neurology intensive care unit is much higher than that.Patients admitted from intensive care unit have the characteristics of critical illness,more indwelling catheters,frequent use of ventilators,more complications,older age,consciousness,language and limb disorders.They are the high-risk population of hospital infection.Once VAP occurs,it will result in prolonged offline time,prolonged hospitalization time and increased probability of iatrogenic infection.It not only increases the cost of medical treatment,but also aggravates the patient's condition,even endangers the patient's life safety.Positive treatment in later stage can help patients improve their condition,but it can not fundamentally control the occurrence of VAP.Therefore,it is particularly important to find out the crux of VAP and take corresponding countermeasures to prevent and control it.ObjectiveTo investigate and analyze the risk factors and pathogen infection of VAP in Neurological intensive care unit(NICU),find out the high risk factors of VAP patients in time,and formulate control measures.To provide a scientific basis for clinicians to fully understand the hazards of VAP in NICU,reduce the incidence of VAP and improve the prognosis of patients,so as to shorten the use time of patients'ventilators,minimize the physiological,psychological and social hazards caused by VAP,and reduce the financial burden of patients and their families.MethodsRetrospective analysis:From January 2011 to December 2017,62 patients with VAP were admitted to the intensive care unit of the Department of Neurology in a tertiary general hospital.62 patients with VAP were selected as the case group,and 62 patients who used ventilator-assisted breathing at the same time without VAP were selected as the control group.19 risk factors leading to VAP were investigated in four categories:(1)treatment-related operations(hospitalization time,ICU stay time,bed time,mechanical ventilation,indwelling gastric tube);(2)general basic conditions((1)sex,age,smoking,drinking;(2)coma;(3)respiratory diseases,diabetes mellitus,hypertension and coronary heart disease;(3)drugs,application(antibiotics combined use(?3),prophylactic use of antibiotics,immuno-suppressants),(4)other(hypoproteinemia,oral hygiene)and so on.Results1.There were 62 patients with VAP.The highest incidence of VAP was Gram-negative bacteria in 39 cases,accounting for 62.90%of the total,followed by Gram-positive bacteria in 19 cases,accounting for 30.65%of the total,and fungi in 4 cases,accounting for 6.45%of the total.(1)Among gram-negative bacteria,Klebsiella pneumoniae was the highest in 18 cases,accounting for 20.03%of the total,followed by Acinetobacter baumannii in 11 cases,accounting for 17.74%of the total,followed by Escherichia coli in8 cases,accounting for 12.90%of the total,and Pseudomonas aeruginosa in 2 cases,accounting for 3.23%of the total.(2)The incidence of Staphylococcus aureus was the highest in 10 Gram-positive bacteria,accounting for 16.13%of the total,followed by Staphylococcus epidermidis in 6 cases,accounting for 9.68%of the total,and Streptococcus pneumoniae in 3 cases,accounting for 4.84%of the total.(3)The fungi were candida,with 4 cases,accounting for 6.45%of the total.2.Through single factor comparative analysis,the results showed that:(1)treatment-related operations:(1)Over 30 days of hospitalization,there were 27cases in the case group(43.55%)and 10 cases in the control group(16.13%).There was a significant difference between the two groups(x~2=11.133,P=0.001).(2)NICU stayed longer than 7 days,with 39 cases in the case group(62.90%)and 27 cases in the control group(43.55%).There was a significant difference between the two groups(x~2=4.665,P=0.031).(3)Excessive bedridden time,especially for more than 7 days,accounted for 56cases(90.32%)in the case group and 46 cases(70.19%)in the control group.There was a significant difference between the two groups(x~2=5.526,P=0.019).(4)Mechanical ventilation lasted more than 7 days,with 54 cases in the case group(87.10%)and 39 cases in the control group(62.90%).There was a significant difference between the two groups(x~2=9.677,P=0.002).(5)37 cases(50.68%)in the case group and 24 cases(38.71%)in the control group.There was a significant difference between the two groups(x~2=5.453,P=0.020).(2)The basic situation of patients themselves:(1)Gender,There were 41 male patients(66.13%)and 21 female patients(33.87%)in the case group,40 male patients(61.52%)and 22 female patients(35.48%)in the control group.There was no significant difference between the two groups(x~2=0.036,P=0.850).(2)Patients over 65 years old,There were38 cases(61.29%)in the case group and 19 cases(30.65%)in the control group.There was significant difference between the two groups(x~2=11.721,P=0.001).(3)Smoking patients,There were 36 cases(50.06%)in the case group and 28 cases(45.16%)in the control group.There was no significant difference between the two groups(x~2=2.067,P=0.151).(4)Drinkers,There were 45 cases(72.58%)in the case group and 33 cases(53.23%)in the control group.There was significant difference between the two groups(x~2=4.977,P=0.026).(5)Coma patients,There were 43 cases in the case group(69.35%)and 30 cases in the control group(48.39%).There were significant differences between the two groups(x~2=5.629,P=0.018).(6)Patients with respiratory diseases,There were 24 cases in the case group(38.71%)and 11 cases in the control group(17.74%).There were significant differences between the two groups(x~2=6.727,P=0.009).(7)Patients with diabetes mellitus,There were 25 cases in the case group(40.32%)and 12 cases in the control group(19.35%).There were significant differences between the two groups(x~2=6.510,P=0.011).(8)Patients with hypertension,There were 21 cases in the case group(33.87%)and 8cases in the control group(12.90%).There were significant differences between the two groups(x~2=7.607,P=0.006).(9)Patients with coronary heart disease,There were 20 cases in the case group(32.26%)and 7 cases in the control group(11.29%).There were significant differences between the two groups(x~2=8.002,P=0.005).(3)Drug therapy:(1)Combined use of antibiotics(>3)in patients,There were 34cases in the case group(54.84%)and 19 cases in the control group(30.65%).There was a significant difference between the two groups(x~2=7.414,P=0.006).(2)Preventive use of antibiotics in patients,There were 29 cases in the case group(46.77%)and 13 cases in the control group(20.97%).There was a significant difference between the two groups(x~2=9.217,P=0.002).(3)Patients with immunosuppressive agents,There were 23 cases in the case group(37.10%)and 10 cases in the control group(16.13%).There was a significant difference between the two groups(x~2=6.978,P=0.0081).(4)other factors:(1)Hypoproteinemia patients,There were 23 cases in the case group(37.10%)and 9 cases in the control group(14.52%).There was a significant difference between the two groups(x~2=8.255,P=0.004).(2)Patients with poor oral hygiene,There were 42 cases in the case group(67.74%)and 25 cases in the control group(40.32%).There was a significant difference between the two groups(x~2=9.384,P=0.002).3.Through multi-factor comparative analysis,the results showed that:(1)Over 30 days of hospitalization,P<0.001 has statistical significance,OR=7.497,OR95%CI:2.687-14.683;(2)NICU stays longer than 7 days,P<0.001 has statistical significance,OR=6.954,OR95%CI:2.288-12.545;(3)For mechanical ventilation over 7 days,P<0.001 has statistical significance,OR=6.238,OR95%CI:2.074-10.369;(4)Patients with diabetes mellitus,P<0.001 has statistical significance,OR=5.516,OR95%CI:1.925~9.687;(5)Combined use of antibiotics(>3),P<0.001 has statistical significance,OR=4.831,OR95%CI:1.563~7.437;(6)Preventive use of antibiotics,P<0.001 has statistical significance,OR=3.962,OR95%CI:1.321~6.462;(7)Hypoproteinemia,P<0.001 has statistical significance,OR=3.149,OR95%CI:1.127~5.332.Conclusion1.Gram-negative bacteria were the highest incidence pathogens of VAP.And Klebsiella pneumoniae was the main pathogen;Gram-positive bacteria were the second,Staphylococcus aureus was the most common;The fungi were the least.And All of them are Candida spp.2.Gender and smoking are not risk factors for VAP;3.Over 30 days in hospital,more than 7 days in ICU,more than 7 days in mechanical ventilation,diabetes mellitus,combined use of antibiotics(>3),prophylactic use of antibiotics and hypoproteinemia were independent risk factors for VAP in neurological intensive care unit. |
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