department of microbiology, Hermanos Ameijeiras Clinical-Surgical Teaching Hospital (HHA), Havana, Cuba.
MEDICC Rev. 2013 Apr;15(2):26-9. doi: 10.37757/MR2013V15.N2.6.
Nosocomial pneumonia associated with use of mechanical ventilators is one of the greatest challenges confronted by intensivists worldwide. The literature associates several bacteria with this type of infection; most common in intensive care units are Acinetobacter baumannii, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and some of the Enterobacteriaceae family.
To identify the causal agents of nosocomial ventilator-associated pneumonia in patients receiving mechanical ventilation in the intensive care units of Havana's Hermanos Ameijeiras Clinical-Surgical Teaching Hospital in 2011, and to characterize their antibiotic resistance.
A cross-sectional descriptive study was conducted using hospital administrative data of quantitative cultures from positive tracheal aspirates for January through December, 2011. Records were analyzed from 77 intensive care unit patients who developed nosocomial ventilator-associated pneumonia. Variables examined were age and sex, and pathogens identified from culture of tracheal aspirate and related antibiotic susceptibility. RESULTS Species most frequently isolated were: Acinetobacter baumannii in 53 patients (68.8%), Pseudomonas aeruginosa in 34 patients (44.2%), other species of Pseudomonas in 15 patients (19.5%), and Serratia marcescens, Klebsiella pneumoniae, and Escherichia coli in 12 patients each (15.6%). Some patients presented more than one pathogen in concurrent or successive infections. Antimicrobial susceptibility testing found high percentages of resistance to antibiotics in all these pathogens. Least resistance was found to colistin.
The prevalence of antibiotic resistance in bacteria causing nosocomial ventilator-associated pneumonia is of concern. Colistin is the drug of choice among the antibiotics reviewed, but sensitivity to other antibiotics should be assessed to search for more appropriate broad-spectrum antibiotics for treating nosocomial ventilator-associated pneumonia. Our results also suggest the need to strengthen infection control efforts, particularly in intensive care units, and to reassess compliance with quality control procedures. Multidisciplinary research involving microbiologists, epidemiologists, internists and intensivists is needed to fully understand the etiological and resistance patterns observed.
医院获得性肺炎与机械通气的使用有关，是全球重症监护医生面临的最大挑战之一。文献中将几种细菌与这种类型的感染联系起来；重症监护病房最常见的是鲍曼不动杆菌、铜绿假单胞菌、耐甲氧西林金黄色葡萄球菌和一些肠杆菌科细菌。
确定 2011 年在哈瓦那 Hermanos Ameijeiras 临床外科学教学医院重症监护病房接受机械通气的患者中与呼吸机相关的医院获得性肺炎的病原体，并对其抗生素耐药性进行特征描述。
采用回顾性描述性研究，使用 2011 年 1 月至 12 月阳性气管抽吸物的定量培养的医院行政数据进行研究。分析了 77 例发生医院获得性呼吸机相关性肺炎的重症监护病房患者的记录。检查的变量包括年龄和性别，以及从气管抽吸物培养中鉴定出的病原体及其相关抗生素敏感性。结果：分离出的最常见的物种是：鲍曼不动杆菌 53 例（68.8%）、铜绿假单胞菌 34 例（44.2%）、其他假单胞菌 15 例（19.5%）、黏质沙雷菌、肺炎克雷伯菌和大肠埃希菌各 12 例（15.6%）。一些患者在并发或连续感染中出现了一种以上的病原体。抗生素敏感性试验发现所有这些病原体对抗生素的耐药率都很高。对粘菌素的耐药性最低。
引起医院获得性呼吸机相关性肺炎的细菌的抗生素耐药性令人担忧。粘菌素是所研究抗生素中首选的药物，但应评估对其他抗生素的敏感性，以寻找更合适的广谱抗生素来治疗医院获得性呼吸机相关性肺炎。我们的结果还表明，需要加强感染控制措施，特别是在重症监护病房，并重新评估对质量控制程序的遵守情况。需要多学科研究，包括微生物学家、流行病学家、内科医生和重症监护医生，以充分了解观察到的病因和耐药模式。
