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目的:研究呼吸机相关多重耐药阴性菌肺炎的感染特点及危险因素。方法:回顾性分析本院呼吸内科ICU2005年至2009年呼吸机相关革兰阴性菌肺炎80例的临床资料,了解其病原体构成及药物敏感性,通过Logistic回归分析呼吸机相关多重耐药阴性菌肺炎感染的危险因素。结果:铜绿假单胞菌、不动杆菌属、肺炎克雷伯菌、大肠埃希菌和嗜麦芽窄食单胞菌等为主要革兰阴性致病菌,各菌株(除嗜麦芽窄食单胞菌外)除对美罗培南、头孢哌酮/舒巴坦有较好的敏感性外,对其他抗生素均耐药明显。机械通气时间(≥5d)、入住ICU(>7d)、抗生素的联用和频繁的更改是多重耐药菌产生的独立危险因素。结论:革兰阴性菌是呼吸机相关性肺炎(VAP)感染的主要病原体且大多呈现多重耐药。减少机械通气时间、严格掌握入住ICU指征和规范抗生素的使用,可以预防多重耐药菌的感染。
Objective: To study the characteristics of infection and risk factors of pneumonia associated with ventilator-associated multi-drug resistant negative bacteria. Methods: The clinical data of 80 cases of ventilator-associated Gram-negative pneumonia in ICU from 2005 to 2009 in our hospital were analyzed retrospectively to understand the pathogen composition and drug sensitivity. Logistic regression was used to analyze the correlation between ventilator-associated multi-drug resistant negative bacteria pneumonia Risk factors for infection. Results: Pseudomonas aeruginosa, Acinetobacter, Klebsiella pneumoniae, Escherichia coli and Stenotrophomonas maltophilia were the main Gram-negative pathogens. All the strains except Stenotrophomonas maltophilia In addition to the meropenem, cefoperazone / sulbactam have better sensitivity, the other antibiotics were drug-resistant. Mechanical ventilation (≥5 days), ICU stay (> 7 days), combination of antibiotics, and frequent changes were independent risk factors for multidrug resistance. Conclusion: Gram-negative bacteria are the main pathogens of ventilator-associated pneumonia (VAP) infection and most of them show multi-drug resistance. Reduce the time of mechanical ventilation, strict control of occupancy ICU indications and regulate the use of antibiotics, can prevent multiple drug-resistant strains of infection.