呼吸机相关性肺炎--近代医疗费用中的隐患和沉重负担

Sharmila Gupta, Debarati Banerjee, Rituparna Haldar
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摘要

背景:呼吸机相关性肺炎(VAP)是指暴露于有创机械通气至少 48 小时的患者的肺实质感染。VAP 是第二大常见的医院获得性感染,死亡率高达 40%:确定 VAP 相关样本的微生物学特征、患者的人口统计学特征以及相关风险因素:在2023年1月至2023年11月的研究期间,收集了73名患者的VAP相关样本,包括气管导管尖端、气管分泌物和支气管肺泡灌洗液(BAL)。此外,还采集了他们的血液样本进行自动血液培养。样本按照标准方案进行处理:在所有患者中,男性占 60.31%,女性占 39.68%。61-80 岁是最常见的患病年龄组。最常分离出的微生物是鲍曼不动杆菌,其对多粘菌素 B 和替加环素的敏感性最高。在 ET 管尖端、气管分泌物和 BAL 液样本中分离出鲍曼不动杆菌和肺炎克雷伯菌的患者中,相关血液培养阳性率最高。许多患者伴有脓毒血症。气管插管和气管抽吸是最常见的相关风险因素:结论:由于伴发脓毒血症可能会成倍增加死亡率,因此还应为疑似 VAP 患者采集血液样本以及与 VAP 相关的样本,以便及早发现脓毒血症,从而更好地管理患者。
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Ventilator-associated pneumonia – An unwanted terror and a loathsome burden on the health-care cost in the recent era
Background: Ventilator-associated pneumonia (VAP) is defined as infection of lung parenchyma in patients exposed to invasive mechanical ventilation for at least 48 h. VAP is the second most common hospital-acquired infection with a mortality rate up to 40%. Aims and Objectives: To determine the microbiological profile of VAP-related samples, the demographic profile of patients, and associated risk factors. Materials and Methods: VAP-related samples including endotracheal tube tip, tracheal secretions, and bronchoalveolar lavage (BAL) fluid were collected from 73 patients during the study period from January 2023 to November 2023. Their blood samples were also collected for automated blood culture. Samples were processed as per standard protocol. Results: Out of the total patients, 60.31% were male and 39.68% were female. 61–80 years was the most commonly affected age group. The most commonly isolated micro-organism was Acinetobacter baumannii with the highest sensitivity to polymixin B and tigecycline. Associated blood culture positivity was maximum in patients whose samples of ET tube tip, tracheal secretions, and BAL fluid had isolated A. baumannii and Klebsiella pneumoniae. Two Candida albicans were isolated with sensitivities to voriconazole and amphotericin B. Many patients had associated septicemia. Endotracheal intubation and tracheal suction were the most common risk factors associated. Conclusion: As associated septicemia may increase the mortality rate manifold blood samples should also be collected in suspected VAP patients along with VAP-related samples for early detection of sepsis leading to better patient management.
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