早发性与晚发性呼吸机相关性肺炎病原菌研究被引量：1

Study on pathogens early-onset and late-onset ventilator-associated pneumonia

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摘要目的:了解重症监护病房(ICU)早发性和晚发性呼吸机相关性肺炎(VAP)病原菌菌谱的构成和临床治疗效果,以提高经验性治疗的疗效。方法:回顾分析了ICU2003～2006年间发生VAP患者的临床资料,分为早发(机械通气时间≤4d)和晚发(机械通气时间>4d)2组。比较2组在病原菌菌谱构成、ICU住院时间、病死率等各方面差异。结果:早发组与晚发组的患者在病死率上无统计学差别。住ICU平均天数存在明显差异[(15.1±16.2)d比(32.3±50.3)d]。早发性VAP与晚发性VAP病原菌无差异,铜绿假单胞菌、鲍曼不动杆菌、洋葱伯克霍尔德菌在早发组和晚发组中占前3位。结论:早发性和晚发性VAP均由多重耐药菌引起,铜绿假单胞菌、鲍曼不动杆菌、洋葱伯克霍尔德菌是常见致病菌。 Objective To investigate the etiology of early-onset and late-onset ventilator-associated pneumonia（VAP）in intensive care unit（ICU） for improving initial empirical antibiotic therapy.Methods A retrospective analysis was performed on data collected from patients admitted to our ICU from 2003 to 2006 who had developed VAP.Altogether 281 cases were enrolled and were divided into early-onset group（≤4 d mechanical ventilation） and late-onset group（〉4 d mechanical ventilation）.Pathogen spectrum,length of ICU stay and mortality were compared between these two groups.Results No difference was noted in mortality between early-onset and late-onset VAP.The average length of ICU stay was significantly longer in patients with late-onset VAP than patients with early-onset VAP（32.3 d vs 15.1 d）.No difference was noted in pathogen spectrum between early-onset and late-onset VAP.Multi-resistant bacteria,mainly Pseudomonas aeruginosa,Acinetobacter baumannii and Burkholeria cepacia,were the most commonly isolated pathogens in both types of VAP.Conclusions Both early-onset and late-onset VAP were mainly caused by multi-resistant bacteria,most commonly Pseudomonas aeruginosa,Acinetobacter baumannii and Burkholeria cepacia.

作者梁英健章志丹肇冬梅朱然马建齐马晓春

机构地区中国医科大学附属第一医院重症医学科

出处《内科理论与实践》 2010年第2期170-172,共3页 Journal of Internal Medicine Concepts & Practice

关键词呼吸机相关性肺炎病原菌重症监护病房多重耐药菌 Ventilator-associated pneumonia Pathogens Intensive care unit Multi-drug resistant bacteria

分类号 R563.1 [医药卫生—呼吸系统] R37 [医药卫生—病原生物学]

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参考文献12

1Clec'h C,Timsit JF,De Lassence A,et al.Efficacy of adequate early antibiotic therapy in ventilator-associated Dneumonia:influence of disease severity[J].Intensive Care.Med,2004,30(7):1327-1333.
2American Thoracic Society;Infectious Diseases Society of America.Guidelines for the management of adults with hospital-acquired,ventilator-associated,and healthcare-associated pneumonia[J].Am J Respir Crit Care Med,2005,171(4):388-416.
3医院获得性肺炎诊断和治疗指南(草案)[J].现代实用医学,2002,14(3):160-161. 被引量：259
4社区获得性肺炎诊断和治疗指南[J].中华结核和呼吸杂志,2006,29(10):651-655. 被引量：3056
5Gaynes R.Health care--associated bloodstream infections:a change in thinking[J].Ann Intern Med,2002,137(10):850-851.
6Giantsou E,Liratzopoulos N,Efraimidou E,et al.Both early-onset and late-onset ventilator-associated pneumonia are caused mainly by potentially muhiresistant bacteria[J].Intensive Care Med,2005,3 1(1 1):1488-1494.
7Giard M,Lepape A,Allaouchiche B,et al.Eady-and late-onset ventilator-associated pneumonia acquired in the intensive care unit:comparison of risk factors[J].J Crit Care,2008,23(1):27-33.
8Ibrahim EH,Ward S,Sherman G,et al.A comparative analysis of patients with early-onset vs late-onset nosocomial pneumonia in the ICU setting[J].Chest,2000,117(5):1434-1442.
9Heyland DK,Cook DJ,Griffith L et al.The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient.The Canadian Critical Trials Group[J].Am J Respir Crit Care Med,1999,159(4 Pt 1):1249-1256.
10Lee HC,Chang KC,Lan CF,et al.Factors associated with prolonged hospital stay for acute stroke in Taiwan[J].Acta Neurol Taiwan,2008,17(1):17-25.

二级参考文献24

1沈定霞,罗燕萍,崔岩,赵莉萍,白立彦.分离产金属β-内酰胺酶的铜绿假单胞菌[J].中华医院感染学杂志,2004,14(1):86-88. 被引量：109
2刘又宁,陈民钧,赵铁梅,王辉,王睿,刘庆锋,蔡柏蔷,曹彬,孙铁英,胡云建,修清玉,周新,丁星,杨岚,卓建生,唐英春,张扣兴,梁德荣,吕晓菊,李胜歧,刘勇,俞云松,魏泽庆,应可净,赵峰,陈萍,侯晓娜.中国城市成人社区获得性肺炎665例病原学多中心调查[J].中华结核和呼吸杂志,2006,29(1):3-8. 被引量：788
3Ngeow YF,Suwanjutha S,Chantarojanasriri T,et al.An Asian study on the prevalence of atypical respiratory pathogens in community-acquired pneumonia.Int J Infect Dis,2005,9:144-153.
4de Roux A,Marcos MA,Garcia E,et al.Viral community-acquired pneumonia in nonimmunocompromised adults.Chest,2004,125:1343-1351.
5Ostrosky-Zeichner L,Alexander BD,Kett DH,et al.Multicenter clinical evaluation of the (1→3) beta-D-glucan assay as an aid to diagnosis of fungal infections in humans.Clin Infect Dis,2005,41:654-659.
6Food and Drug Administration,HHS.Class Ⅱ Special Controls Guidance Document:serological assays for the detection of betaglucan.Fed Reqist,2004,69:56934-56936.
7Mandell LA,Marrie TJ,Grossman RF,et al.Canadian guidelines for the initial management of community-acquired pneumonia:an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society.The Canadian CommunityAcquired Pneumonia Working Group.Clin Infect Dis,2000,31:383-421.
8Woodhead M,Blasi F,Ewig S,et al.Guidelines for the management of adult lower respiratory tract infections.Eur Respir J,2005,26:1138-1180.
9Mandell LA,Bartlett JG,Dowell SF,et al.Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults.Clin Infect Dis,2003,37:1405-1433.
10Fine MJ,Auble TE,Yealy DM,et al.A prediction rule to identify low risk patients with community-acquired pneumonia.N Engl J Med,1997,336:243-250.