儿科重症监护室患者的呼吸机相关肺炎:微生物学概况,危险因素和结果
Piyali Bhattacharya1, Arvind Kumar2, Sanat Kumar Ghosh3
1Paediatrics, Mata Gujri Memorial (MGM) Medical College, Kishanganj, IND.
Cureus
|May 30, 2023
概括
儿童的呼吸机相关肺炎 (VAP) 通常是由格兰氏阴性细菌引起的,长时间的机械通风是关键的危险因素. 虽然VAP增加了住院时间,但这项研究发现与死亡率没有显著的关联.
科学领域:
- 儿科 儿科 儿科
- 传染性疾病 传染性疾病
- 关键护理医学 关键护理医学
背景情况:
- 呼吸机相关性肺炎 (VAP) 是儿科重症监护室 (PICU) 中的一种严重并发症,与高发病率和死亡率有关.
- 了解特定的致病因子,风险因素和VAP的结果对于儿童重症监护机构的有效预防和管理策略至关重要.
研究的目的:
- 为了调查入住儿科重症监护病房的儿童中VAP的微生物特征.
- 为了确定与这种患者群体中VAP发展相关的风险因素.
- 确定与儿童VAP相关的结果,包括死亡率.
主要方法:
- 进行了一项观察性横截面研究,涉及37例被诊断为儿童VAP的病例.
- VAP诊断是基于临床肺部感染得分大于6,通过气管培养和胸部X射线证实.
- 收集和分析了患者人口统计,临床因素,微生物学发现和结果的数据.
主要成果:
- VAP的发病率为36.2%,其中1-5岁的年龄组受影响最大.
- 最常见的致病性生物体是*Pseudomonas aeruginosa* (29.8%),*Klebsiella pneumoniae* (21.6%),*Staphylococcus aureus* (18.9%) 和*Acinetobacter* (13.5%),这些都是最常见的致病性生物.
- 与VAP显著相关的因素包括类固醇使用,镇静,再输管,以及更长时间的机械通风 (平均15天而不是7天). 在VAP病例中死亡率为48.54%,与非VAP病例没有显著差异 (p=0.0843).
结论:
- 儿童的VAP经常是由阴性细菌引起的,特别是在长时间的机械通风的情况下.
- VAP与延长机械呼吸,PICU住院和整体住院有关,但与死亡率的增加无关.
- 针对性预防策略侧重于风险因素,如长时间通风,类固醇使用和镇静,有必要减少PICU中的VAP发病率.
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