三级医院重症监护病房呼吸机相关肺炎患者的发病率、风险因素和微生物学特征

Anil Kumar Behera, H. Guruprasad, Shivram, Navoday, Divya, Madhusudhan Reddy, Bharadwaj, Manswini, Atahullah
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摘要

背景:VAP 或呼吸机相关肺炎是重症监护病房最常见的疾病之一,也是导致重症监护病房患者死亡的一个重要原因。在医疗资源有限的南亚地区,目前对感染性疾病的估计不足。目的研究三级医院重症监护室患者 VAP 的发病率、相关风险因素和微生物学特征。方法选取符合所有纳入标准的 114 名机械治疗患者。进行了详细的病史和检查。根据临床和实验室检查结果(按照疾病预防控制中心的标准)做出 VAP 诊断,并根据 ICU 呼吸机支持患者总数中发生 VAP 的患者人数得出发病率。研究结果研究共纳入 114 名患者。研究对象的平均年龄为(61.29±13.42)岁。114 名患者中有 80 名男性,占 70.2%;34 名女性,占 29.8%。男女比例为 2.3:1。肺炎克雷伯菌是培养物中常见的微生物,占 30.7%,其次是绿脓杆菌(27.2%)和鲍曼不动杆菌(19.3%)。肺炎克雷伯氏菌的抗生素敏感性模式显示,20 例(57.1%)对碳青霉烯酶耐药,15 例(42.9%)对 ESBL 耐药。在我们的研究中,死亡率为 17.5% 结论:VAP 的治疗效果取决于能否快速识别致病微生物。基于对最常见微生物及其耐药性模式的了解而采取的经验性治疗可降低 VAP 患者的发病率和死亡率、缩短住院时间、降低治疗费用并防止 MDR 细菌的发展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Incidence, Risk Factors and Microbiological Profile of Ventilator Associated Pneumonia Patients in ICU in Tertiary Care Hospital
Background: VAP, or ventilator-associated pneumonia, is one of the most common ICU-acquired diseases and a significant cause of mortality among Intensive Care Unit patients. Infectious illnesses are currently underestimated in the South Asian Region, which has limited health resources. Objective: To examine the incidence of VAP, risk factors associated and the microbiological profile in ICU patients in tertiary care hospitals. Methods: A total of 114 patients under mechanical who satisfied all inclusion criteria were selected. Detailed history, investigations were undertaken. The diagnosis of VAP was made according to clinical and laboratory findings (as per CDC criteria) and incidence was derived from the number of patients developing VAP out of the total number of patients on ventilatory support in ICU. Results: We included 114 patients in our study. Out of 114 patients, the majority were above 70 years age group Mean age of study population was 61.29±13.42 years. Out of 114, 80 patients i.e. 70.2% were males and 34(29.8%) were females. Male: female ratio was 2.3:1. Klebsiella Pneumonia was a commonly observed organism in cultures i.e. 30.7%, followed by Pseudomonas Aeruginosa in 27.2% and Acinetobacter Baumani in 19.3%. Antibiotic sensitivity pattern of Klebsiella Pneumonia showed resistance to Carbapenemase in 20(57.1%) cases and to ESBL in 15(42.9%) cases. Death rate in our study was 17.5% Conclusion: The outcome of VAP depends on rapid identification of the causative microorganism. Empirical therapy based on knowledge of the most prevalent microorganisms and their resistance pattern has an impact on lowering morbidity and mortality, shortening the length of hospital stay, lowering of treatment expenses, and prevents the development of MDR bacteria in patients with VAP.
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