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目的探讨呼吸机相关性肺炎(VAP)的病原分布、耐药特点及相关易感因素。方法收集2008年2月-2010年9月ICU病房患儿321例,诊断为VAP 79例,采集VAP患儿痰液或下呼吸道分泌物进行病原菌培养与药敏试验,分析其病原菌分布、耐药情况及相关易感因素。结果小儿VAP发生率为24.6%;主要致病菌为革兰阴性菌(铜绿假单胞菌、肺炎克雷伯菌、洋葱伯克霍尔德菌、鲍氏不动杆菌、不动杆菌等);其中对头孢西丁耐药率最高(67.9%),哌拉西林他唑巴坦最低(18.5%);相关易感因素主要包括年龄、抗生素使用情况、机械通气时间、是否合并基础疾病、有无鼻饲、是否进行体外插管操作等。结论机械通气患儿发生VAP概率较高,应及时、准确掌握VAP致病菌及其耐药性,并对其相关易感因素进行干预。
Objective To investigate the pathogen distribution, drug resistance and related susceptibility factors of ventilator-associated pneumonia (VAP). Methods 321 patients with ICU ward, 79 cases diagnosed as VAP were collected from February 2008 to September 2010, sputum or lower respiratory secretions from children with VAP were collected for pathogen culture and susceptibility testing, and the distribution of pathogens and drug resistance were analyzed Situation and related susceptibility factors. Results The incidence of VAP in children was 24.6%. The main pathogenic bacteria were Gram-negative bacteria (Pseudomonas aeruginosa, Klebsiella pneumoniae, Burkholderia cepacia, Acinetobacter baumannii, Acinetobacter, etc.) (67.9%) were the most resistant to cefoxitin and the lowest (18.5%) was piperacillin-tazobactam. The related predisposing factors included age, antibiotic use, duration of mechanical ventilation, whether there was underlying disease or not, No nasal feeding, whether to conduct intubation operations and so on. Conclusions The incidence of VAP in children with mechanical ventilation is high, and pathogens and drug resistance of VAP should be grasped promptly and accurately, and the intervention of their related susceptibility factors should be made.