中国药房2025，Vol.36Issue(16)：2051-2056,6.DOI:10.6039/j.issn.1001-0408.2025.16.17
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
Analysis of risk factors for multidrug resistance in patients with ventilator-associated pneumonia complicated by prolonged invasive mechanical ventilation in the ICU
摘要
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.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.关键词
有创机械通气/呼吸机相关性肺炎/多重耐药/危险因素Key words
invasive mechanical ventilation/ventilator-associated pneumonia/multidrug resistance/risk factors分类
医药卫生引用本文复制引用
胡童童,陈泳伍,胡志成..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[J].中国药房,2025,36(16):2051-2056,6.基金项目
安徽省教育厅高等学校2022年度科研计划项目(No.2022AH040184) （No.2022AH040184）
