摘要
目的:探讨呼吸机相关性肺炎(ventilator associated pneumonia,VAP)死亡与高黏液表型肺炎克雷伯菌感染的相关性。方法:选取2014-02-01～2018-06-30入住重症监护病房(ICU)接受机械通气发生肺炎克雷伯菌感染的VAP患者1 328例为研究对象,用纤维支气管镜采集其深部痰标本进行细菌培养及药敏试验,深部痰标本中分离出高黏液表型肺炎克雷伯菌感染患者107例为观察组,非高黏液表型肺炎克雷伯菌患者中642例为对照组,采用回顾巢式病例对照研究设计,用多因素Logistic回归模型分析比较高黏液表型肺炎克雷伯菌感染与VAP死亡的相关性。结果:两组入住ICU时间与总住院时间比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,高黏液表型肺炎克雷伯菌感染是VAP死亡的高危因素(OR=2.500,95%CI:1.366～4.574)。观察组VAP死亡患者抗菌药物使用时间长于存活患者(P<0.05)。结论:VAP高黏液表型肺炎克雷伯菌感染已成为临床严重问题,一旦感染将会显著增加患者病死率。
Objective:To evaluate the correlation between ventilator associated pneumonia(VAP)death and Klebsiella pneumoniae infection in high mucus phenotype.Methods:A total of1 328 patients who received mechanical ventilation for Klebsiella.pneumoniae infection were included in intensive care unit(ICU)from February 2014 to June 2018.Deep sputum specimens were collected by fiberoptic bronchoscopy for bacterial culture and drug sensitivity test,107 cases of high mucus phenotype klebsiella pneumoniae infection were selected as observation group and 642 cases of non-hyperviscous phenotype klebsiella pneumoniae infection were selected as control group.A retrospective nested case-control study design was used to compare the difference in VAP death between the high mucus phenotype Klebsiella pneumoniae infection.Results:There were statistically significant difference in total hospital stay and length of stay in ICU between the two groups(P <0.05).Logistic analysis showed high mucus phenotypes of Klebsiella pneumoniae was the higher risk factor for VAP death(OR=2.500,95%CI:1.366-4.574).Died patients in the observation group received antibiotrci time was longer than those who survived(P <0.05).Conclusion:VAP with Klebsiella pneumoniae infection in high mucus phenotype has become serious problem in clinic,which can significantly increase the incidence of death.
作者
谢朝云
陈应强
熊芸
杨忠玲
杨怀
XIE Zhaoyun;CHEN Yingqiang;XIONG Yun;YANG Zhongling;YANG Huai(The Third Affiliated Hospital of Guizhou Medical University Department of Infection Control,Duyun 558000,China;The Third Affiliated Hospital of Guizhou Medical University Department of Infection Disease,China;The Third Affiliated Hospital of Guizhou Medical University Department of Clinical Laboratory,Duyun 558000,China;Department of Infection Control,People's Hospital of Guizhou)
出处
《西北国防医学杂志》
CAS
2019年第1期24-28,共5页
Medical Journal of National Defending Forces in Northwest China
基金
贵州省科技厅联合项目(黔科合LH字2014-7162)
贵州省黔南州社会发展科技项目(黔南科合社字2013-20)
关键词
高黏液表型肺炎克雷伯菌
呼吸机相关性肺炎
死亡
关联性
病例对照研究
high mucus phenotype Klebsiella pneumoniae
ventilator associated pneumonia
death,correlation
case-control study
作者简介
谢朝云(1968-),男,水族,主任医师,E-mail:xcu2009@163.com.
