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ICU长时间有创机械通气并发呼吸机相关性肺炎患者的多重耐药危险因素分析
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| 篇名： | ICU长时间有创机械通气并发呼吸机相关性肺炎患者的多重耐药危险因素分析 |
| TITLE： | Analysis of risk factors for multidrug resistance in patients with ventilator-associated pneumonia complicated by prolonged invasive mechanical ventilation in the ICU |
| 摘要： | 目的 分析重症医学病房（ICU）行长时间有创机械通气（IMV）且并发呼吸机相关性肺炎（VAP）患者发生多重耐药菌（MDRO）感染的危险因素，为提高本地区VAP临床治疗效果提供参考。方法回顾性收集2022年10月－2025年2月入住浙江大学医学院附属第二医院歙县分院（以下简称“我院”）ICU行长时间IMV且并发VAP患者的临床资料，统计其病原菌分布及耐药情况；根据患者是否发生MDRO感染，将其分为MDRO组和非MDRO组，采用单因素分析和多因素Logistic回归分析筛选患者发生MDRO感染的独立危险因素。结果纳入的97例患者共培养出病原菌281株，其中革兰氏阴性菌262株（93.24%）、革兰氏阳性菌9株（3.20%）、真菌10株（3.56%）。革兰氏阴性菌以铜绿假单胞菌、肺炎克雷伯菌肺炎亚种、鲍曼不动杆菌为主，前两者对亚胺培南等常用抗菌药物的耐药率较高（均不低于25%），鲍曼不动杆菌对大多数抗菌药物都有较高的耐药率；革兰氏阳性菌以金黄色葡萄球菌金黄亚种、溶血葡萄球为主，对克林霉素等多种抗菌药物耐药（耐药率均高于30%）。281株病原菌中，有121株为MDRO，有62株对碳青霉烯类药物耐药，有33株产超广谱β-内酰胺酶。血清白蛋白＜28g/L、入住ICU时间≥14d、使用苯二氮类药物均是导致我院ICU行长时间IMV且并发VAP患者发生MDRO感染的独立危险因素（比值比分别为3.289、2.991、2.680，95%置信区间分别为1.183～9.144、1.021～8.765、1.012～7.094，P＜0.05）。结论我院ICU行长时间IMV且并发VAP患者感染病原菌以革兰氏阴性菌为主，其中铜绿假单胞菌、肺炎克雷伯菌肺炎亚种和鲍曼不动杆菌的占比较高，耐药情况较为严峻；血清白蛋白＜28g/L、入住ICU时间≥14d、使用苯二氮类药物是导致该类患者发生MDRO感染的独立危险因素。 |
| ABSTRACT： | OBJECTIVE To analyze the risk factors for multidrug-resistant organism （MDRO） infection in patients with prolonged invasive mechanical ventilation （IMV） complicated by ventilator-associated pneumonia （VAP） in the intensive care unit （ICU）， thus providing a reference for improving the clinical effect of VAP treatment in this region. METHODS A retrospective analysis was performed on the clinical data of patients who were admitted to the ICU in Shexian Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine （hereinafter referred to as “our hospital”） from October 2022 to February 2025， received prolonged IMV， and developed VAP. The distribution and drug resistance of pathogens were statistically analyzed. Patients were divided into the MDRO group and the non-MDRO group according to whether an MDRO infection occurred. Univariate analysis and multivariate Logistic regression analysis were used to screen independent risk factors for MDRO infection. RESULTS A total of 281 pathogenic strains were cultured from 97 patients， including 262 Gram-negative bacteria （93.24%）， 9 Gram-positive bacteria （3.20%）， and 10 fungi （3.56%）. The main Gram-negative bacteria were Pseudomonas aeruginosa， Klebsiella pneumoniae subspecies pneumoniae， and Acinetobacter baumannii. The former two showed high resistance rates （all≥25%） to common antibiotics such as imipenem， while A. mail：64375689@qq.com baumannii demonstrated high resistance to most antimicrobial agents. The main Gram-positive bacteria were Staphylococcus aureus subspecies aureus and S. haemolyticus， which were resistant to multiple antibiotics such as clindamycin （resistance rates all＞30%）. Among 281 pathogenic strains， 121 were MDRO， 62 were resistant to carbapenems， and 33 produced extended-spectrum β-lactamases. The serum albumin＜28 g/L， ICU stay≥14 days， and use of benzodiazepines were independent risk factors for MDRO infection in patients with prolonged IMV and VAP in our hospital’s ICU （odds ratios were 3.289， 2.991 and 2.680， 95% confidence intervals were 1.183-9.144， 1.021-8.765， and 1.012- 7.094， respectively， P＜0.05）. CONCLUSIONS Pathogens infecting patients with prolonged IMV and VAP in the ICU are mainly Gram-negative bacteria， with P. aeruginosa， K. pneumoniae subspecies pneumoniae and A. baumannii， accounting for a high proportion， and the drug resistance situation is severe. Serum albumin＜28 g/L， ICU stay≥14 days， and use of benzodiazepines are independent risk factors for MDRO infection in such patients. |
| 期刊： | 2025年第36卷第16期 |
| 作者： | 胡童童；陈泳伍；胡志成 |
| AUTHORS： | HU Tongtong，CHEN Yongwu，HU Zhicheng |
| 关键字： | 有创机械通气；呼吸机相关性肺炎；多重耐药；危险因素 |
| KEYWORDS： | invasive mechanical ventilation； ventilator-associated pneumonia； multidrug resistance； risk factors |
| 阅读数： | 8 次 |
| 本月下载数： | 0 次 |
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