摘要
目的分析内科重症监护病房(RICU)呼吸机相关性肺炎(VAP)病原菌耐药特点以及口腔消毒对VAP的预防效果。方法以入住RICU的115例VAP患者作为研究对象,经气管插管获取VAP患者下呼吸道分泌物,采用巧克力平板和血琼脂平板法进行菌群培养、分离和鉴定,采用纸片扩散法(K-B法)进行药敏试验;以115例VAP患者作为对照组,选择同期住院105例VAP患者为观察组,对照组患者的口腔常规清水清洁,观察组患者采用复方氯己定含漱液清洁口腔,比较两组患者细菌检出率、发热时间及住院时间。结果115例VAP患者共分离出313株病原菌,革兰阴性菌、阳性菌及真菌分别有182株(58.1%)、107株(34.2%)及24株(7.7%),两种及以上病原菌感染者有55例(47.8%);病原菌检出率最高的分别为铜绿假单胞菌(20.8%)、鲍曼不动杆菌(17.6%)、金黄色葡萄球菌(15.3%);药敏分析显示,铜绿假单胞菌和鲍曼不动杆菌对哌拉西林/他唑巴坦敏感性较好,金黄色葡萄球菌和肺炎链球菌对万古霉素较为敏感;经口腔消毒后,观察组患者细菌检出率和发热时间均低于对照组,差异有统计学意义(P<0.05)。结论RICU中VAP患者主要以革兰阴性菌感染为主,多种病原菌混合感染也常见,口腔消毒护理可减轻VAP感染症状。
Objective To investigate and analyze the drug resistance characteristics of pathogenic bacteria causing ventilator-associated pneumonia(VAP)in respiratory intensive care unit(RICU)and the preventive effect of oral disinfection on VAP.Methods A total of 115 inpatients with VAP in RICU was recruited as control group,and 105 inpatients with VAP at the same period were selected as observation group.Control group was routinely given with water to clean oral cavity,while observation group was treated with compound chlorhexidine gargle.The secretions from the lower respiratory tracts of the patients with VAP were obtained using tracheal intubation and seeded on the chocolate plates and blood agar plates to culture to grow bacteria in the secretions.Bacteria were isolated and identified.The sensitivity of identified bacteria to drugs was tested by Kirby-Bauer paper diffusion(K-B method).The bacterial detection rates,fever time,and hospitalization time of two groups were compared.Results A total of 313 strains of pathogenic bacteria were isolated from 115 patients with VAP,among which,182 strains(58.1%)were Gram-negative bacteria,107 strains(34.2%)positive bacteria and 24 strains(7.7%)fungi,respectively.There were 55(47.8%)patients infected with two or more pathogenic bacteria in observation group.The pathogen with the highest detection rate was Pseudomonas aeruginosa(20.8%),followed by Acinetobacter baumannii(17.6%)and Staphylococcus aureus(15.3%).Drug sensitivity analysis showed that P.aeruginosa and A.baumannii were sensitive to piperacillin/tazobactam,while S.aureus and Streptococcus pneumoniae were sensitive to vancomycin.After oral disinfection,the bacterial detection rate and fever time were lower in observation group than those in control group(P<0.05).Conclusion The patients with VAP in RICU are mainly infected by gram-negative bacteria.It is also common that the patients with VAP are infected by multiple pathogenic bacteria.Oral disinfection may effectively reduce the degree of VAP infection.
作者
贾铁钢
乜庆荣
邓赶飞
JIA Tiegang;NIE Qingrong;DENG Ganfei(Department of Respiratory and Critical Care Medicine,Beijing Fangshan District Liangxiang Hospital,Beijing 102401,China)
出处
《贵州医科大学学报》
CAS
2022年第7期847-851,共5页
Journal of Guizhou Medical University
基金
国家重点研发计划(2016YFC1304405)
北京市科技计划课题(D151100002115004)。
关键词
呼吸内科重症监护病房
呼吸机相关性肺炎
病原菌
药物敏感性
耐药性
口腔消毒
respiratory intensive care unit(RICU)
ventilator-associated pneumonia(VAP)
pathogenic bacteria
drug sensitivity
drug resistance
oral disinfection
