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1995-2004年某医院呼吸重症监护病房呼吸机相关性肺炎病原菌的变迁及其影响因素
其他题名The changing patterns and the associated factors of microbial pathogens in ventilator-associated pneumonia in a respiratory intensive care unit from 1995 to 2004
杨薇; Bei, H E; 赵鸣武; Wan-zhen, YAO
关键词呼吸监护病房 肺炎,呼吸机相关性 Respiratory care unit Pneumonia,ventilator-associated
刊名中华结核和呼吸杂志
2008
DOI10.3321/j.issn:1001-0939.2008.08.011
31期:8页:598-602
收录类别中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型Journal Article
摘要目的 了解1995-2004年北京大学第三医院(简称本院)呼吸重症监护病房(RICU)呼吸机相关性肺炎(VAP)病原菌的变化特点及其影响因素.方法 回顾性分析1995-2004年在本院RICU住院并使用机械通气的VAP患者137例,其中1995-1999年47例;2000-2004年90例.VAP的诊断符合以下标准:肺炎出现在气管插管48 h后,影像学表现为新发现的或进展性浸润阴影,且至少有以下2种临床表现:(1)体温>38.0℃或<35.5℃;(2)白细胞>10×109/L或<4×109/L;(3)有脓性分泌物,同时细菌培养阳性(气管插管取标本).使用SPSS 11.5软件分析数据,定量资料用x±s表示,独立样本采用t检验,定性资料采用χ2检验.对于各个统计变量采用logistic多元回归分析以确定特殊病原菌VAP的易患因素.结果 (1)1995-2004年本院RICU中VAP总发病率为17.9%(137/765);1995-1999年47例,平均发病率为16.2%(3.1%~29.8%);2000-2004年90例,平均发病率为19.6%(12.4%~27.7%).(2)1995-1999年检出的病原菌中居前4位的分别为嗜麦芽黄窄食单胞菌(15株,23.4%)、铜绿假单胞菌(12株,18.8%)、阴沟肠杆菌(8株,12.5%)及鲍曼不动杆菌(7株,10.9%).2000-2004年居前4位的病原菌为鲍曼不动杆菌(40株,34.2%)、铜绿假单胞菌(32株,27.4%)、金黄色葡萄球菌(24株,20.5%)及嗜麦芽黄窄食单胞菌(8株,6.8%).1995-1999年金黄色葡萄球菌感染2株(2/64,3.1%),均为耐甲氧西林的金黄色葡萄球菌(MRSA),2000-2004年24株金黄色葡萄球菌感染中21株(21/117,17.9%)为MRSA.(3)1995-1999年中心静脉置管11例(11/47,23.4%),2000-2004年为45例(45/90,50.0%);雾化吸入时间分别为(46±55)和(28±30)d;使用二代头孢类抗生素为12例(12/47,25.5%)和7例(7/90,7.8%),使用青霉素类抗生素为13例(13/47,27.7%)和10例(10/90,11.1%),使用喹诺酮类抗生素为10例(10/47,21.3%)和46例(46/90,51.1%).(4)金黄色葡萄球菌性VAP的发生可能与同期住院患者的相互传播有关(Wald值=16.690,P<0.01,OR=9.212);嗜麦芽黄窄食单胞菌性VAP的发生与雾化吸入时间有关(Wald值=7.852,P<0.01,OR=1.021);鲍曼不动杆菌性VAP的发生与使用三代头孢类抗生素有关(Wald值=5.553,P<0.05,OR=3.461).结论 10年来本院RICU中VAP的发病率未增加;鲍曼不动杆菌和金黄色葡萄球菌及MRSA明显增多;RICU病原菌的变迁可能与雾化吸入时间下降、经验性使用抗生素种类不同及同期患者院内传播有关. Objective To investigate the changing patterns and associated factors of microbial pathogens which caused ventilator-associated pneumonia (VAP) in our respiratory intensive care unit (RICU) from 1995 to 2004. Methods Cases of VAP in our RICU from 1995 to 2004 (n=137) were retrospectively analyzed, 47 cases from 1995 to 1999 and 90 cases from 2000 to 2004. YAP was diagnosed according to the following criteria: pneumonia occurred 48 hours after tracheal intubatioas; new or progressive infiltrative opacities on chest X ray film; and at least two of the following clinical features: (1) Temperature > 38. 0 ℃ or < 35. 5 ℃, (2)WBC > 10×109/L or < 4×109/L, (3)purulent airway secretions; and positive bacterial cultures (the samples obtained through endotracheal intubations). The data were analyzed using statistical software SPSS version 11.5. Continuous data were expressed as x±s. T-test and χ2-test were used for continuous and categorical data, respectively. Logistic regression analysis was used to determine the risk factors for special pathogens. Results The mean incidence of VAP was 17. 9% from 1995 to 2004 (137/765), 16. 2% from 1995 to 1999 (n = 47, 3.1% - 29. 8%) and 19.6% from 2000 to 2004 (n =90, 12. 4% -27. 7%). From 1995 to 1999, common pathogens were Stenotrophomonas maltophilia (n =15, 23.4%), Pseudomonas aeruginosa (n = 12, 18.8%), Aerobacter cloacae (n = 8, 12.5%) and Acinetobacter baumanii (n = 7, 10. 9%). From 2000 to 2004, common pathogens were Acinetobacter baumanii (n =40, 34. 2%), Pseudomonus aeruginosa (n =32, 27.4%), Staphylococcus aureus (n =24,20. 5%) and Stenotrophomonus maltophilia (n =8, 6. 8%). There were 2 cases (2/64,3.1%) caused by Staphylococcus aureus from 1995 to 1999, and both were caused by Methicillin-resistant Staphylococcus aureus (MRSA) ; there were 24 cases caused by Staphylococcus aureus from 2000 to 2004 , and 21 cases (21/117,17.9%) were caused by MRSA. There were 11 (11/47,23.4%) and 45 (45/90,50. 0%) cases with central intravenous catheters in the period of 1995 to 1999 and 2000 to 2004, respectively. In the period of 1995 to 1999 and 2000 to 2004, durations of aerosolized therapy were (46±55) and(28±30) days. There were 12 patients (12/47,25.5%) using second-generation cephalosporin before VAP occurred in the period of 1995 to 1999 and 7 patients(7/90,7. 8%) in the period of 2000 to 2004. There were 13 patients (13/47,27. 7%) using penicillin before VAP in the period of 1995 to 1999 and 10 patients (10/90,11.1%) in the period of 2000 to 2004. There were 10 patients (10/47,21.3 %) using quinolones before VAP in the period of 1995 to 1999 and 46 patients (46/90,51.1%) in the period of 2000 to 2004. The occurrence of Staphylococcus aureus VAP may be related to the cross-infection between inpatients (Wald =16. 690,P <0. 01, OR = 9. 212). VAP caused by Stenotrophomonas maltophilia was positively related to duration of aerosolized therapy (Wald = 7. 852, P < 0.01, OR = 1. 021). VAP caused by Acinetobacter baumanii was positively related to third-generation cephalosporin usage (Wald = 5. 553, P < 0. 05, OR =3.461). Conclusions The incidence of VAP was not increased in the recent 10 years in our RICU, but the incidence of VAP caused by Acinetobocter baumanii. Staphylococcus aureus and MRSA increased significantly, may be related to the decrease of duration of aerosolized therapy, the usage of different kinds of antibiotics and cross-infection between inpatients.
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文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/71293
专题北京大学第三临床医学院_呼吸科
作者单位1.北京大学第三医院呼吸内科,100083
2.Department of Respiratory Medicine,Third Hospital of Peking University,Beijing 100083,China
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杨薇,Bei, H E,赵鸣武,等. 1995-2004年某医院呼吸重症监护病房呼吸机相关性肺炎病原菌的变迁及其影响因素[J]. 中华结核和呼吸杂志,2008,31(8):598-602.
APA 杨薇,Bei, H E,赵鸣武,&Wan-zhen, YAO.(2008).1995-2004年某医院呼吸重症监护病房呼吸机相关性肺炎病原菌的变迁及其影响因素.中华结核和呼吸杂志,31(8),598-602.
MLA 杨薇,et al."1995-2004年某医院呼吸重症监护病房呼吸机相关性肺炎病原菌的变迁及其影响因素".中华结核和呼吸杂志 31.8(2008):598-602.
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