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Objective To analyze the risk factors and pathogen distribution of ventilator-associated pneumonia (VAP) in patients following coronary artery bypass grafting (CABG).Methods The clinical data of 1414 patients undergoing CABG in Teda International Cardiovascular Hospital from June 2014 to June 2016 were retrospectively analyzed .The VAP developed following CABG in 42 patients ( VAP group ) and not occurred in 1372 patients ( non-VAP group) .Multivariate logistic regression was used to analyze the risk factors of VAP in patients after CABG , and the microbial culture and drug sensitivity test were performed in VAP patients.Results The incidence rate of VAP after CABG was 2.97％ (42/1414).Multivariate logistic regression analysis showed that history of smoking ( OR =2.216, 95％ CI 1.018 -4.825, P <0.05), mechanical ventilation time >48 h (OR=7.457, 95％ CI 3.443-16.161, P<0.01), LVEF<40％(OR=3.524 , 95％ CI 1.203-10.325, P<0.05) and postoperative acute kidney injury (OR=16.239, 95％ CI 7.551 -34.924, P <0.01) were independent risk factors for VAP in patients after CABG.A total of 42 pathogen strains were detected in 42 patients with VAP, including 37 strains of Gram-negative bacteria, 2 strains of Gram-positive bacteria, and 3 strains of fungus.Gram-negative bacteria mainly were Klebsiella pneumoniae subspecies ( n =23, 54.76％) and Burkholderia cepacia ( n =6, 14.27％);the Gram-positive bacteria were Staphylococcus aureus ( n =2, 4.76％);the fungus was Candida albicans ( n =3, 7.14％).Klebsiella pneumoniae was sensitive to many antibiotics;and the resistance rate to amikacin , aztreonam , meropenem , and levofloxacin was <10％, the resistance rate to ceftazidime and piperacillin was <25％. Burkholderia cepacia was naturally resistant to amikacin , ampicillin, aztreonam, cefazolin, gentamicin and sulfamethoxazole .Conclusion The incidence of VAP was higher in patients after CABG , and the involved pathogens were mainly Gram-negative bacteria .Clinically , it is necessary to take necessary measures to prevent and treat VAP in order to improve the prognosis of patients undergoing CABG .
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OBJECTIVE:To study the influence of oscillator on the cleanliness of class 100 clean bench in PIVAS. METH-ODS:Using sedimentated bacteria and the number of dust particle as index,in common drug configuration room,antibiotics con-figuration room and risk drugs configuration room including biological safety cabinet and horizontal laminar flow,the cleanliness of class 100 clean bench were monitored when oscillator was set at clean bench and different positions in work and non-working state. RESULTS & CONCLUSIONS:In working and non-working state of oscillator,there was no difference in sedimentated bacteria and the number of dust particle which was in line with the requirements of 2010 edition of GMP,i.e. the application and location of oscillator didn't influence the cleanliness of class 100 clean bench. From a view of safety,it is suggested to place the oscillator in the left(or right)posterior wall of clean table when biological safety cabinets is used to dispense antibiotic and risk drugs.
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OBJECTIVE:To evaluate the effects of pharmaceutical care in PIVAS of our hospital,and to improve the quality and level of pharmaceutical care. METHODS:Combined with the actual situation of our hospital,various measures which had been carried out in PIVAS of our hospital were analyzed retrospectively,and the effects of pharmaceutical care were also analyzed. RESULTS & CONCLUSIONS:Through strengthening safety awareness,formulating effective management system,continuous op-timization process to guarantee the quality of drug dispensing,and focusing on the ability to improve the quality of the team,an ef-fective improvement has gained in the quality of pharmaceutical care. The proportion of irrational medical order of anti-tumor intra-venous drug use has decreased from 0.62% in 2008 to 0.09% in 2012. 1 363 irrational medical orders have been checked out dur-ing Jul.-Dec. of 2014,accounting for 0.39% in total. The satisfactory degree of clinical staff has increased from 80.0% to 98.5%. PIVAS has a positive role in promoting pharmaceutical care.