|本期目录/Table of Contents|

[1]邹燕子 陈茂刚 朱明训 王 宁 焦 云 陆霞君.呼吸机相关肺炎患者病原菌分布、炎症指标及耐药性分析[J].中华肺部疾病杂志,2021,(04):492-495.[doi:10.3877/cma.j.issn.1674-6902.2021.04.024]
点击复制

呼吸机相关肺炎患者病原菌分布、炎症指标及耐药性分析(PDF)

《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:
期数:
2021年04期
页码:
492-495
栏目:
临床研究
出版日期:
2021-08-20

文章信息/Info

Title:
-
作者:
邹燕子 陈茂刚 朱明训 王 宁 焦 云 陆霞君
215129 江苏,苏州高新区人民医院重症医学科
Author(s):
-
关键词:
呼吸机相关肺炎;  病原菌;  炎症反应指标;  耐药性
Keywords:
-
分类号:
R563
DOI:
10.3877/cma.j.issn.1674-6902.2021.04.024
摘要:
目的 分析呼吸机相关肺炎(VAP)患者的病原菌分布、炎症反应指标及耐药性。方法 前瞻性入选2018年10月至2020年9月于我院接受机械通气并确诊为VAP的患者76例,同时入选无明确感染的机械通气患者35例作为对照组。对VAP患者的病原菌分布及耐药性进行分析,比较两组患者炎症反应指标的表达。结果 在VAP患者中共分离菌株89株,其中革兰阴性菌61株(68.54%),革兰阳性菌18株(20.22%),真菌10株(12.23%)。革兰阴性菌以鲍曼不动杆菌、大肠埃希菌、嗜麦芽寡养单胞菌、铜绿假单胞菌和肺炎克雷伯菌为主,革兰阳性菌以金黄色葡萄球菌、表皮葡萄球菌和肺炎链球菌为主,真菌以白念珠菌和热带念珠菌为主。细菌的耐药率整体较高,真菌的耐药率整体较低。TNF-α、CRP、PCT、IL-6和IL-10在两组间的表达差异明显(P<0.05),其中VAP患者组各炎症反应指标表达水平均高于对照组。结论 VAP患者的病原菌以革兰阴性菌为主,在菌种不明的早期应首选针对革兰阴性菌的抗生素。定期检测TNF-α、CRP、PCT、IL-6和IL-10等炎症反应因子,对VAP的诊断、治疗和预后具有临床意义。
Abstract:
-

参考文献/References:

1 张 鹏, 周 健, 王耀丽, 等. 外周血Th17细胞对呼吸机相关性肺炎的早期诊断价值[J/CD]. 中华肺部疾病杂志(电子版), 2016, 9(2): 150-153.
2 Sousa AS, Ferrito C, Paiva JA. Application of a ventilator associated pneumonia prevention guideline and outcomes: A quasi-experimental study[J]. Intensive Crit Care Nurs, 2019, 51(4): 50-56.
3 Pozuelo-Carrascosa DP, Torres-Costoso A, Alvarez-Bueno C, et al. Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review.[J]. J Physiother, 2018, 64(4): 222-228.
4 赵 婧, 张丽琴, 张冬泉, 等. 基于中国生物医学文献数据库的VAP研究现状的可视化分析 [J]. 中华危重病急救医学, 2018, 30(11): 1029-1035.
5 Zhao XY, Feng JH, Zhang Li, et al. One functional variant in the 3'-untranslated region of TLR4 is associated with the elevated risk of ventilator-associated pneumonia in the patients with chronic obstructive pulmonary disease.[J]. J Cell Physiol, 2019, 234(10): 18879-18886.
6 Wongsurakiat P, Tulatamakit S. Clinical pulmonary infection score and a spot serum procalcitonin level to guide discontinuation of antibiotics in ventilator-associated pneumonia: a study in a single institution with high prevalence of nonfermentative gram-negative bacilli infection.[J]. Ther Adv Respir Dis, 2018, 12: 1-13.
7 中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)[J]. 中华结核和呼吸杂志, 2018, 41(4): 255-280.
8 李小鹏, 王治国. 美国临床实验室标准化委员会标准与指南 [J]. 中华检验医学杂志, 2001, 24(4): 251-252.
9 Osman S, Al TYM, Aldabbagh M, et al. The incidence of ventilator-associated pneumonia(VAP)in a tertiary-care center: Comparison between pre- and post-VAP prevention bundle.[J]. J Infect Public Health, 2020, 13(4): 552-557.
10 谢三红. 探究呼吸机相关性肺炎病因及HMGB1与预后的关系[J/CD]. 临床检验杂志(电子版), 2020, 9(3): 40-41.
11 Abd-Elmonsef MME, Elsharawy D, Abd-Elsalam AS. Mechanical ventilator as a major cause of infection and drug resistance in intensive care unit[J]. Environ Sci Pollut Res Int, 2018, 25(31): 30787-30792.
12 Ciginskiené A, Dambrauskien A, Rello J, et al. Acinetobacter baumannii ventilator-associated pneumonia due to drug-resistant: risk factors and mortality relation with resistance profiles, and independent predictors of in-hospital mortality.[J]. Medicina(Kaunas), 2019, 55(2): 1-13.
13 Niu TS, Luo QX, Li YQ, et al. Acinetobacter baumannii comparison of tigecycline or cefoperazone/sulbactam therapy for bloodstream infection due to Carbapenem-resistant [J]. Antimicrob Resist Infect Control, 2019, 8(1):1-12.
14 Denis J-B, Lehingue S, Pauly V, et al. Multidrug-resistant Pseudomonas aeruginosa and mortality in mechanically ventilated ICU patients.[J]. Am J Infect Control, 2019, 47(9): 1059-1064.
15 Persyn E, Sassi M, Aubry M, et al. Rapid genetic and phenotypic changes in pseudomonas aeruginosa clinical strains during ventilator-associated pneumonia.[J]. Sci Rep, 2019, 9(1): 4720.
16 王新美, 黄新忠, 张 俊, 等. 血液净化中心肺炎克雷伯菌血流感染调查分析 [J]. 中国病原生物学杂志, 2019, 156(12): 80-84.
17 何泽燕, 赵秋良, 费 玲. 替考拉宁对比万古霉素对耐甲氧西林金黄色葡萄球菌性呼吸机相关肺炎的疗效与安全性评价[J]. 贵州医药, 2017, 41(4): 367-369.
18 Abdelsalam MFA, Abdalla MS, El-Abhar HSE. Prospective, comparative clinical study between high-dose colistin monotherapy and colistin-meropenem combination therapy for treatment of hospital-acquired pneumonia and ventilator-associated pneumonia caused by multidrug-resistant Klebsiella pneumoniae.[J]. J Glob Antimicrob Resist, 2018, 15(10): 127-135.
19 Salehifar E, Tavakolian AS, Aliyali M, et al. Role of C-reactive protein and tumor necrosis factor-alpha in differentiating between ventilator-associated pneumonia and systemic inflammatory response syndrome without infectious etiology.[J]. Tanaffos, 2016, 15(4): 205-212.
20 Ding HG, Zhou HF, Diao MY, et al. A novel biomarker of serum Histidine-Rich Glycoprotein(HRG)for diagnosing and predicting prognosis of ventilator-associated pneumonia(VAP): a pilot study.[J]. Eur Rev Med Pharmacol Sci, 2018, 22(22): 7920-7927.
21 Miroliaee AE, Salamzadeh J, Shokouhi S, et al. The study of vitamin D administration effect on CRP and Interleukin-6 as prognostic biomarkers of ventilator associated pneumonia[J]. J Crit Care, 2018, 44(4): 300-305.

备注/Memo

备注/Memo:
基金项目: 苏州高新区医疗卫生科技计划项目(2020Z012)
通信作者: 陆霞君, Email: luxiajun@126.com
更新日期/Last Update: 2021-08-20