呼吸机相关性肺炎的病原学特点-内科急危重症杂志.docVIP

呼吸机相关性肺炎的病原学特点及其对临床预后的影响 张素花1 朱进1 李秀华2 （1.南京医科大学附属南京第一医院急诊科，江苏南京210006；2.上海市浦东新区周浦医院上海（ventilator-associated pneumonia，VAP）8.49±4.36 vs. 26.06±14.90（P=0.001），总住院天数分别为28.11±25.51 vs. 42.88±31.41（P=0.020）58.33% vs.45.83%（P=0.257）。VAP和NON-VAP组机械通气天数分别是16.82±38.83 vs.6.66±5.28（P=0.018），ICU住院天数分别为24.16±40.42 vs. 11.79±11.63（P=0.007），住院期间病死率分别为54.12% vs. 39.67%（P=0.023）。结论：我院ICU中VAP的致病菌以铜绿假单胞菌、鲍氏不动杆菌及肺炎克雷伯菌等革兰氏阴性杆菌最常见，其中早发型VAP致病菌以肺炎克雷伯菌、铜绿假单胞菌及金黄色葡萄球菌为主，而晚发型VAP致病菌以鲍氏不动杆菌、铜绿假单胞菌及肺炎克雷伯菌（Emergency Department, Nanjing First Hospital Affiliated to NJMU，Nanjing 210006，China） Abstract] Objective: We retrospectively investigated microbial aetiology and the impact on clinical outcomes of VAP in ICUs in our hospital. Methods: Patients who were admitted to ICU of our hospital and were mechanically ventilated for＞48 h from June 2013 and to Decmber 2014 were retrospectively investigated. All these patients were divided into two groups, ventilator-associated pneumonia group (VAP group) and non-ventilator-associated pneumonia group (NON-VAP group). Furthermore, VAP group was divided into two groups, early-onset VAP and late-onset VAP. Respiratory secretions of all patients were cultured. Then clinical outcomes of patients were reviewed in each group. Results: 96 bacterial isolates were cultured from 85 patients with VAP. There were 79 gram-negative bacterias(82.29%) , most of which were Pseudomonas aeruginosa, Acinetobacter spp and Klebsiella pneumoniae. 72 patients (84.71%) with VAP had monomicrobial infection and 13 patients (15.29%) had polymicrobial infection. 38 isolates were cultured from 36 patients with early-onset VAP, mainly including Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. 58 isolates were cultured from 49 patients with late-onset VAP, which mainly were Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae. 7 multi-drug resistant pathogens were obtained from patients with early-onset VAP, while 24 isolates were obtained