Abstract：【Objective】To investigate the clinical characteristics,drug resistance and prognosis of ventilator-associated pneumonia (VAP) caused by Candida albicans combined with Acinetobacter baumannii. 【Methods】A total of 128 patients with VAP caused by Candida albicans combined with Acinetobacter baumannii who were admitted to our hospitals from March 2018 to July 2021 were selected as the research objects. The clinical characteristics and drug resistance of the patients were analyzed. After 4 weeks of follow-up,the factors for patient prognosis were analyzed as well. 【Results】The clinical features of 128 patients with VAP caused by Candida albicans combined with Acinetobacter baumannii were mostly cough,expectoration,dyspnea,fever,and blisters in the lungs. Candida albicans strains are more sensitive to mycotoxins and clotrimazole,whose resistance rates were 0 and 6.25%,respectively. However,the resistance rates to other antibiotics were all >10%. Acinetobacter baumannii strains were sensitive to tigecycline and minocycline,with resistance rates of 0 and 23.44%,respectively. And its resistance rates to other antibiotics were all >30%. Logistic multivariate regression analysis showed that albumin,acute physiology and chronic health evaluation score Ⅱ(APACHE Ⅱ),clinical pulmonary infection score (CPIS),secondary tracheal intubation,antibiotic use time were factors that affected the prognosis of VAP patients caused by candida combined with acinetobacter baumannii (P<0.05). 【Conclusion】The clinical characteristics of patients with VAP caused by candida albicans combined with acinetobacter baumannii are diverse,and they are highly resistant to a variety of commonly used antibiotics. The first choices for clinical treatment of VAP caused by candida albicans combined with acinetobacter baumannii were mycotoxins,clotrimazole,tigecycline and minocycline. Albumin,APACHE Ⅱ score,CPIS score,secondary tracheal intubation,antibiotic use time are the factors that affect the prognosis of patients with VAP caused by Candida and Acinetobacter baumannii.
[1] JENKINS-LONIDIER L. Pulmonary infections,including ventilator-associated pneumonia[J].Crit Care Nurs Clin North Am,2021,33(4):381-393.
[2] ALI KARIMPOUR H,HEMATPOUR B,MOHAMMADI S,et al. Effect of nebulized eucalyptus for preventing ventilator-associated pneumonia in patients under mechanical ventilation:a randomized double blind clinical trial[J].Altern Ther Health Med,2020,26(2):126-130.
[3] BART S M,RUBIN D,KIM P,et al. Trends in hospital-acquired and ventilator-associated bacterial pneumonia trials[J].Clin Infect Dis,2021,73(3):602-608.
[4] 唐瑾,张文,徐小妹,等. 血浆可溶性晚期糖基化终产物受体水平在危重患者呼吸机相关性肺炎预后中的意义[J].内科急危重症杂志,2021,27(2):121-124.
[5] 中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)[J].中华结核和呼吸杂志,2018,41(4):255-280.
[6] 陈佰义,何礼贤,胡必杰,等. 中国鲍曼不动杆菌感染诊治与防控专家共识[J].中华医学杂志,2012,92(2):76-85.
[7] 中华医学会呼吸病学分会感染学组. 肺真菌病诊断和治疗专家共识[J].中华结核和呼吸杂志,2007,30(11):821-834.
[8] HUMPHRIES R M,AMBLER J,MITCHELL S L,et al. CLSI methods development and standardization working group best practices for evaluation of antimicrobial susceptibility tests[J].J Clin Microbiol,2018,56(4):1934-1937.
[9] PAN K,PANWAR A,ROY U,et al. A comparison of the intracerebral hemorrhage score and the acute physiology and chronic health evaluation Ⅱ score for 30-day mortality prediction in spontaneous intracerebral hemorrhage[J].J Stroke Cerebrovasc Dis,2017,26(11):2563-2569.
[10] GUNALAN A,SISTLA S,SASTRY A S,et al. Concordance between the national healthcare safety network (NHSN) surveillance criteria and clinical pulmonary infection score (CPIS) criteria for diagnosis of ventilator-associated pneumonia (VAP)[J].Indian J Crit Care Med,2021,25(3):296-298.
[11] 王强,杨承健,张晓璞,等. COVID-19不同时期防控措施对NSTEMI住院患者并发肺部感染的诊断和预后影响[J].医学临床研究,2021,38(12):1764-1766.
[12] 臧舒婷,王龙安,任莹,等. 呼吸机相关性肺炎预后预测方法[J].中华医院感染学杂志,2021,31(3):370-375.
[13] 刘银梅,吴晓松,杨惠英,等. 耐碳青霉烯类肺炎克雷伯菌呼吸机相关肺炎发病及预后危险因素[J].中华医院感染学杂志,2020,30(22):3378-3383.
2022, Vol. 39 
