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首页> 外文期刊>Iranian journal of clinical infectious diseases >Bacteriologic Evaluation of Ventilator-Associated Pneumonia According to Stress Related Mucosal Disease Prophylaxis in the Intensive Care Unit
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Bacteriologic Evaluation of Ventilator-Associated Pneumonia According to Stress Related Mucosal Disease Prophylaxis in the Intensive Care Unit

机译：重症监护病房根据应激相关性粘膜疾病的预防对呼吸机相关性肺炎的细菌学评估

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Ventilator associated pneumonia is one of the most important nosocomial infections with often poor outcomes and heavy economic burdens on health care systems.Several studies have been done for evaluating the effect of different types of stress related mucosal disease (SRMD) prophylaxis on nosocomial pneumonia, as among factors participating in its establishment, gastrointestinal tract is believed to play an important role especially in ventilator-associated pneumonia.In this cross-sectional study, 150 patients who were admitted to intensive care unit (ICU) and developed documented culture positive VAP, were evaluated for the study inclusion criteria. The patients with clinical pulmonary infection score (CPIS) a?￥ 6 were included and some others with conditions affecting comparability excluded. The patients with Acute Physiology and chronic health evaluation II (APACHEII) scores between 10 and 24, within the first 24 hours of ICU stay, were included. Finally, 100 patients who fulfilled all criteria were evaluated for the responsible organisms and type of SRMD prophylaxis they had received. The patients included were either on intravenous pantoprazole (49 patients) or intravenous ranitidine (51 patients). The goal of this study was to evaluate the organisms, which have been isolated from the sputum of ICU patients with ventilator-associated pneumonia, according to their SRMD prophylaxis regimen.There were 59 men (59%) and 41 women (41%) ranging from 19 to 82 years old. The mean ages were not significantly different between the two groups (P = 0.586). APACHEII score was ranging between 15 and 21 with the mean of 17.57 in pantoprazole and 16.80 in ranitidine group (P = 0.006), there was a statistical but not clinical difference. With P-value of 0.001, there was significant difference in ICU stay days. The mean mortality rates were 18.4% and 1.8% for pantoprazole and ranitidine group, respectively. The difference was statistically significant (P & 0.001). Multi-drug resistant pathogens were significantly higher in the pantoprazole group (0.001). The organisms, which have been obtained from each group were different. Acinetobacter and Pseudomonas aeruginosa were highly cultivated in the pantoprazole group, while Staphylococcus aureus and Proteus were more in patients who had received ranitidine.It can be suggested that each bacterium has a unique propensity to grow in specific gastric pH and other systemic changes made by various agents used for SRMD prophylaxis. More studies are needed to evaluate large number of patients receiving SRMD prophylaxis, with perspective of VAP incidence, the responsible organisms, hospital and ICU stay days, and mortality rate in order to prevent poor outcomes caused by specific organisms.
机译：呼吸机相关性肺炎是最重要的医院感染之一，其结果通常很差，给医疗保健系统造成了沉重的经济负担。已进行了多项研究，以评估不同类型的压力相关性粘膜疾病（SRMD）预防对医院内肺炎的影响，例如在参与其建立的因素中，胃肠道被认为是重要的作用，尤其是在呼吸机相关性肺炎中。在这项横断面研究中，有150例入院重症监护病房（ICU）并发展成文献证明为培养阳性的VAP评估研究纳入标准。纳入临床肺部感染评分（CPIS）≥6的患者，另一些影响可比性的患者除外。在ICU住院的最初24小时内，急性生理和慢性健康评估II（APACHEII）评分在10到24之间的患者也包括在内。最后，对100名符合所有标准的患者进行了评估，评估了他们接受的负责任微生物和SRMD预防类型。纳入的患者要么接受静脉注射pan托拉唑（49例患者），要么接受静脉注射雷尼替丁（51例患者）。这项研究的目的是根据SRMD预防方案评估从ICU呼吸机相关性肺炎患者的痰中分离出的微生物，男性59例（59％），女性41例（41％）从19岁到82岁。两组之间的平均年龄没有显着差异（P = 0.586）。 APACHEII评分介于15到21之间，pan托拉唑平均为17.57，雷尼替丁组平均为16.80（P = 0.006），但无统计学差异。 P值为0.001，ICU住院天数存在显着差异。 pan托拉唑和雷尼替丁组的平均死亡率分别为18.4％和1.8％。差异具有统计学意义（P ＜0.001）。 pan托拉唑组的多药耐药病原体明显更高（0.001）。从每组中获得的生物是不同的。 pan托拉唑组高度培养不动杆菌和铜绿假单胞菌，接受雷尼替丁治疗的患者中金黄色葡萄球菌和变形杆菌较多，这表明每种细菌在特定的胃pH和其他各种系统性变化引起的系统变化中都有独特的生长倾向。用于SRMD预防的药物。需要更多的研究来评估大量接受SRMD预防的患者，并从VAP发生率，负责任的生物体，医院和ICU的住院天数以及死亡率等方面进行评估，以防止特定生物体导致不良后果。

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