综合重症监护病房呼吸机相关性肺炎监测分析

目的了解综合重症监护病房(ICU)呼吸机相关性肺炎(VAP)感染率、危险因素、病原菌分布及其耐药情况,探讨有针对性的预防控制措施。方法 2009年1月-12月综合ICU共收治患者447例,采用主动监测方法,由ICU医务人员和专职人员每日对综合ICU病房住院时间≥48 h且撤停机械通气后48 h内的患者进行VAP监测。结果 447例患者中住院时间≥48 h的患者168例,96例患者使用呼吸机,使用呼吸机时间182 d,ICU住院总日数1 339 d,发生VAP 17例,呼吸机使用率13.59%,VAP感染率93.4例/1 000机械通气日,根据平均病情严重程度(ASIS法)调整后的VAP感染率为2.38%。呼吸机使用方式与VAP发生有关联。检出病原菌18株,全部为Gˉ杆菌,其中鲍曼不动杆菌4株,对包括硫霉素、氨曲南在内的多种抗菌药物耐药。结论综合ICU病房VAP感染率为2.38%,呼吸机使用不当是VAP的危险因素,VAP致病菌为Gˉ杆菌,其中鲍曼不动杆菌耐药率达100%,并呈多重耐药性;抗生素使用时间过长,预防性使用不当是致病菌产生多重耐药的重要原因。

Monitoring and Analysis of Ventilator-associated Pneumonia in Intensive Care Unit

Objective To observe the incidence,pathogens distribution and resistance rate of ventilator-associated pneumonia(VAP) in intensive care unit(ICU) of our hospital in order to investigate the targeted prevention and control measures.Methods From January to December 2009,447 patients were treated in ICU.Active surveillance of VAP was carried out by medical staff of ICU and professional fulltime staff for patients who stayed in ICU for more than 48 hours within 48 hours of extubation from mechanical ventilation.Results Among the 447 patients,168 had their ICU stay time longer than 48 hours.Ninety-six patieuts used ventilator,and the total time of using ventilator was 182 days,and the total hospitalization time was 1 339 days.Seventeen patients had VAP.The VAP infection rate and the ventilator using rate were 93.4 case/1 000 days of mechanical ventilation and 13.59% respectively.The VAP infection rate fell to 2.38% when calculated by ASIS modification according to the average severity.The way of using the ventilator was associated with VAP infection.Eighteen strains of bacteria were checked out and all of the pathogens were Gram-negative bacilli,among which 4 strains were acinetobacter baumannii which could resist various antibiotics including thienamycin and aztreonam.Conclusions The VAP infection rate is 2.38% in ICU.Improper use of ventilators is the risk factor for VAP which is caused by Gram-negative bacilli.The resistance rate of hemolytic acinetobacter baumannii reaches 100% and presents as multi-drug resistant.The key reason of multi-drug resistance is improper or excessively long use of antibiotics.