Distribution and drug resistance of pathogens isolated from lower respiratory tract in patients with ventilator-associated pneumonia

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Author:
XU Jian-guo(Intensive Care Unit, the Third People's Hospital in Wenzhou, Wenzhou 325000, China)
WU Hong-mei()
XU Zi-qin()
JIN Xian-guan(Intensive Care Unit, the Third People's Hospital in Wenzhou, Wenzhou 325000, China)
LI Yu(Intensive Care Unit, the Third People's Hospital in Wenzhou, Wenzhou 325000, China)
Journal Title:
Chinese Journal of Clinical Infectious Diseases
Issue:
Volume 05, Issue 04, 2012
DOI:
10.3760/cma.j.issn.1674-2397.2012.04.005
Key Word:
Pneumonia, ventilator-associated; Intensive care unit; Drug resistance

Abstract: Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from lower respiratory tracts of early onset and late-onset ventilator-associated pneumonia (VAP)patients in intensive care unit. Methods A retrospective analysis was performed on data collected from1324 patients admitted to the ICU in the Third People' s Hospital in Wenzhou from July 2008 to December 2011 who received invasive mechanical ventilation.Patients were divided into early-onset pneumonia group (EOP,≤ 4 d mechanical ventilation ) and late-onset pneumonia group (LOP, > 4 d mechanical ventilation).x2 or t test was performed to compare the pathogen distribution and antimicrobial resistance between two groups.Results In 1324 patients,552 (41.7%) suffered from VAP,including 74 ( 5.6% )patients with EOP,382 (28.9%) patients with LOP,and 96 (7.3%) patients with both EOP and LOP.The top 6 pathogens in EOP group were Acinetobacter baumannii ( 72,22.6% ),Pseudomonas aeruginosa (45,14.1% ),Klebsiella pneumoniae (32,10.0% ),Canidia albicans ( 31,9.7% ),Burkholderia cepacia ( 31,9.7% ) and Staphyloccocus aureus ( 28,8.8% ) ; and in LOP group were Acinetobacter baumannii (235,21.2% ),Canidia albicans (201,18.1% ),Pseudomonas aeruginosa ( 111,10.0% ),Candida glabrata ( 86,7.8% ),Klebsiella pneumoniae ( 81,7.3% ) and Staphyloccocus aureus ( 46,4.2% ).Staphylococcus aureus infection in EOP group was more common than that in the LOP group (x2 =10.780,P =0.002),but the separation rate of Candida albicans in EOP group was significantly lower than that in the LOP group (x2 =12.907,P =0.000).Gram-negative bacteria isolated from EOP or LOP group were both highly resistant to most commonly used antibacterial agents,especially for Acinetobacter baumannii and Pseudomonas aeruginosa strains. Most Staphyloccocus aureus strains were methicillin-resistant strains (EOP:67.9%,19/28; LOP:63.0%,29/46).Canidia albicans and Candida glabrata were sensitive to most antifungal agents.Conclusion For both EOP and LOP groups,the majority of pathogens isolated from lower respiratory tract are Gram-negative bacteria,and drug resistance is serious.

  • [1]中华医学会呼吸病学分会.医院获得性肺炎诊断和治疗指南(草案).中华结核和呼吸杂志,1999,22(4):201-203.
  • [2]中华人民共和国卫生部医政司.全国临床检验操作规程.3版.南京:东南大学出版社,2006:472-550.
  • [3]Mandelli M, Mosconi P, Langer M, et al.Is pneumonia developing in patients in intensive care always a typical "nosocomial" infection?.Lancet,1986,2(8515):1094-1095.
  • [4]American Thoracic Society,Infectious Diseases Society of America.Guidelines for the management of adults with hospital-acquired ventilator associated and healthcare associated pneumonia.Am J Respir Crit Care Med,2005,171 (4):388-416.
  • [5]Cook D. Ventilator associated pneumonia:perspectives on the burden of illness.Intensive Care Med,2000,26 Suppl 1:S31-S37.
  • [6]徐锋,阎锡新,梁希军,呼吸机相关性肺炎的流行病学和诊治进展.国际呼吸杂志,2009,29(14):880-883.
  • [7]Erdem 1,Ozgultekin A,Inan AS,et al.Incidence,etiology,and antibiotic resistance patterns of gram-negative microorganisms isolated from patients with ventilator-associated pneumonia in a medical-surgical intensive care unit of a teaching hospital in istanbul,Turkey (2004-2006).Jpn J Infect Dis,2008,61(5):339-342.
  • [8]Chulay M.VAP prevention.The latest guidelines.RN,2005,68(3):52-56.
  • [9]Bahrt G.Current methods for combating VAP.Nuts Manage,2009,40(4):49-52.
  • [10]Lisboa T,Kollef MH,Rello J.Prevention of VAP:the whole is more than the sum of its parts.Intensive Care Med,2008,34(6):985-987.
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