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The Study on the Characteristics of Pathogenic Bacteria of Ventilator-associated Pneumonia in ICU from 2005 to 2009

Author: ZhangXiaoChun
Tutor: HuangMin
School: Dalian Medical University
Course: Pathogen Biology
Keywords: Ventilator-associated pneumonia ICU Pathogen resistance rates Antibiotic
CLC: R563.1
Type: Master's thesis
Year: 2010
Downloads: 87
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Abstract

Objective: The ventilator is a powerful means of respiratory support in critically ill patients with respiratory failure triggered with the wide application of the ventilator in the ICU (intensive care unit, ICU), ventilator-associated pneumonia (ventilator-associated pneumonia, VAP) is increasing. Ventilator-associated pneumonia is a the concurrent lung parenchyma in patients receiving mechanical ventilation 48h infection, is one of the major complications of mechanical ventilation in patients with the most common nosocomial infection in the ICU. Event VAP will prolong the duration of mechanical ventilation, the patient's condition can be caused by repeated-on time. VAP is a common nosocomial infection in the general hospital ICU, hospital infections increased mortality, length of stay to be extended and the cost of treatment increased mainly due to seriously affect the prognosis of the patients with mechanical ventilation. VAP pathogens in multi Gram-negative bacilli mainly usually accounts for 80%, 10% -15% of Gram-positive cocci, fungal infections accounted for 5% -10%. Bacterial infections accounted for the first three Pseudomonas aeruginosa (26.8%) (18.8%) and Klebsiella spp (14.1%), Acinetobacter spp. A number of studies show that the flora easily lead to irrational use of antimicrobial drugs to change the patient's normal microbial parasitic use of ventilator patients in critical condition, often dropped or suppressed immune function, can not effectively remove pathogens, the incidence of VAP opportunities increase bacterial resistance change. Therefore, to study the incidence of VAP mechanism and prevention measures for clinical improve the level of application of mechanical ventilation, improve the survival rate of critically ill patients and reduce mortality, reduce health care costs have important practical significance. The purpose of this study is to rational use of antimicrobial drugs by studying the the VAP pathogens distribution characteristics and its resistance for clinical treatment of VAP reference. Materials and methods: 1, General Information: July 2005 to July 2009, in critically ill patients admitted to ICU department of the First Affiliated Hospital of China Medical University, 2685 cases of patients requiring mechanical ventilation, which occurred VAP 697 cases , the rate was 25.96%. VAP patients, 404 cases of male and female 293 cases; an average age of 64.24 ± 14.095 years. VAP diagnostic criteria and exclusion criteria: duration of mechanical ventilation more than 48h; X-ray showed emerging or persistent or progressive shadow; and has three or more of the following three indicators the: ① hypothermia gt; 38.0 ° C or lt; 35.5 ° C; ② blood leukocytes gt; 10 x 109 / L and (or) a left shift or lt; 3 1 09; the ③ tracheal aspirate property Gram stain high magnification gt; 1 0 leukocytes; ④ trachea secretions positive bacterial culture. Case exclusion criteria: ① mechanical ventilation ≤ 24h by; ② mechanical ventilation before the diagnosis of pneumonia; (3) mechanical ventilation within 72h death or automatically discharged from hospital; ④ due to the oropharynx and trachea trauma or surgery patients and ventilator had used intubated patients. Specimen collection: 48 hours of mechanical ventilation in patients, clean the mouth after using disposable sterile suction catheter or fiberoptic bronchoscopy pollution prevention brush, draw the lower respiratory tract secretions, placed in a closed sterile containers immediately inspected. And every 24-48h collected specimens were cultured strain identification and susceptibility testing until patients to stop using the ventilator. 4, bacterial identification and susceptibility test: bacterial culture, two - fold agar dilution method in accordance with the guiding principles of American Committee of Clinical Laboratory Standards (NCCLS), two consecutive train the same strain was identified as pathogens. All strains France biological Mei Aili the VITEK microbial fully automatic analyzer for bacterial identification. The culture medium for bacteria MH agar medium recommended by the WHO. Susceptibility testing by KB method and results are judged according to the NCCLS (1999 edition) standard to judge. , Statistical analysis method: the information entered into the computer, the application of SPSS 16.0 software for statistical analysis. Χ2 test was used to compare the rate, the statistical significance level of provisions for α = 0.05. Results: 1,2005 to 2009, the First Affiliated Hospital ICU Division of VAP occurred in patients: five years between 2005 to 2009, the number of mechanical ventilation, ICU department of the First Affiliated Hospital of China Medical University, the number of VAP cases occurred The VAP incidence increased year by year. Pathogen test results found that about 50% of the patients with VAP is a mixture of a variety of bacteria infection. VAP pathogen distribution and changes characteristics: 2.1 VAP pathogens distribution of the genus 2005-2009 isolates were 152, 184, 306, 336 and 411, a total of 1389. Gram-negative bacilli in the past five years are the first VAP pathogens constitute a ratio above 70%. Gram-positive cocci Overall, in second place, third place is a fungus. Only in the last year of 2009 fungal constituent ratio is 16.1% higher than 12.2% of the Gram-positive cocci, rose VAP pathogens. 2.2, VAP pathogens changes VAP pathogens in the top few are Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Klebsiella pneumoniae, Burkholderia cepacia, Stenotrophomonas narrow food Aeromonas bacteria and Escherichia coli. Staphylococcus aureus VAP most important Gram-positive cocci, and only the top few non-gram-negative bacilli. Top few strains of Gram-negative bacilli 5 years almost no change, just change the ranking order between them. Pseudomonas aeruginosa constituent ratio of no major changes almost all more than 20%, is the most important pathogens of VAP. Acinetobacter bacillus five years between the constituent ratio and sort a clear upward trend, has leaped to the 2009 one (32.8%), the upward trend is most obvious strains. The fungi constitute relatively stable than in 2009 (8.5%) in 2009, a sudden rise to 16.1%, more than Gram-positive cocci. VAP strains resistant: 3.1, Gram-negative bacteria era of antibiotic resistance rates change 3.1.1 Pseudomonas aeruginosa in 2005-2009 generally has a very high resistance to various antibiotics , compared to imipenem and meropenem resistant performance is slightly lower. 3.1.2 Acinetobacter baumannii in five years, has a higher resistance to most antibiotics, and the resistance rate showed a rising trend significantly. In contrast, the lower resistance rates to cefoperazone / sulbactam. 3.1.3 Klebsiella pneumoniae five years between the rate of resistance to various antibiotics commonly than Pseudomonas aeruginosa and Acinetobacter baumannii lower resistance rates of imipenem and meropenem pole is low. 3.1.4 Burkholderia cepacia, most of the antibiotic resistance rates are not high, only the relatively high rate of resistance to amikacin and imipenem. 3.1.5 Stenotrophomonas maltophilia Aeromonas five years between the various types of antibiotic resistance rates are very high, however levofloxacin and cotrimoxazole has shown high sensitivity. 3.1.6 Escherichia coli 5 years with a high degree of sensitivity to hydrocarbon enzyme based drugs (imipenem and meropenem) exhibit very high resistance rates to most other antibiotics. 3.2 gram-positive bacteria era of antibiotic resistance rate changes susceptibility testing results show that Staphylococcus aureus has a very high resistance to many antibiotics, the contrast MRSA with antibiotics resistance generally higher. Staphylococcus aureus only exhibited a high degree of sensitivity of these two antibiotics of teicoplanin and vancomycin. 3.3, fungi era of antibiotic resistance rates changes the corresponding antibiotic sensitivity were higher Candida albicans and Candida tropicalis, Candida tropicalis small part of lower sensitivity rate is due to the small sample size. Conclusion: the five years between 2005 to 2009, the First Affiliated Hospital of China Medical University the ICU department VAP incidence is increasing every year, about 50% of patients with VAP is a mixture of a variety of bacteria infection. Gram-negative bacilli in the past five years are the first VAP pathogens. Gram-positive cocci Overall, in second place, third place is a fungus. 2009 fungi constitute higher than the Gram-positive cocci, rose to second place VAP pathogens. Top few VAP pathogens were Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Klebsiella pneumoniae, Burkholderia cepacia, Stenotrophomonas maltophilia Bacteria Escherichia coli. Susceptibility testing results show that the Pseudomonas aeruginosa and Acinetobacter baumannii generally have a higher resistance to various antibiotics in 2005-2009, Klebsiella pneumoniae resistant to various antibiotics generally higher than The first two to be lower. Staphylococcus aureus has a very high resistance to many antibiotics, compared to the resistance of MRSA with antibiotics generally higher. Staphylococcus aureus only exhibited a high degree of sensitivity of these two antibiotics of teicoplanin and vancomycin. The sensitivity of the fungus on the appropriate antibiotics were higher.

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