ICU内早发和晚发呼吸机相关肺炎风险因素比较

David

J Crit Care. 2008 Mar;23(1):27-33. Epub 2007 Dec 11. Links
Early- and late-onset ventilator-associated pneumonia acquired in the intensive care unit: comparison of risk factors.
ICU内早发和晚发呼吸机相关肺炎风险因素比较
Giard M, Lepape A, Allaouchiche B, Guerin C, Lehot JJ, Robert MO, Fournier G, Jacques D, Chassard D, Gueugniaud PY, Artru F, Petit P, Robert D, Mohammedi I, Girard R, Cêtre JC, Nicolle MC, Grando J, Fabry J, Vanhems P.
Laboratory of Epidemiology and Public Health, CNRS UMR 5558, Lyon 1 University, 69008 Lyon, France; Infection Control Unit, Edouard Herriot Hospital, 69437 Lyon cedex 03, France.

PURPOSE: To compare risk factors of early- (E) and late-onset (L) ventilator-associated pneumonia (VAP). MATERIALS AND METHODS: An epidemiological survey based on a nosocomial infection surveillance program of 11 intensive care units (ICUs) of university teaching hospitals in Lyon, France, was conducted. A total of 7236 consecutive ventilated patients, older than 18 years and hospitalized in ICUs for at least 48 hours, were studied between 1996 and 2002. Data during ICU stay, patient-dependent risk factors, device exposure, nosocomial infections occurrence, and outcome were collected. The cutoff point definition between E-VAP (</=6 days) and L-VAP (>six days) was based on the daily hazard rate of VAP. RESULTS: The VAP incidence rate was 13.1%, 356 (37.6%) E-VAP (within 6 days of admission) and 590 (62.4%) L-VAP were reported. Independent risk factor for E-VAP vs L-VAP was surgical diagnostic category (odds ratio [OR], 1.49 [95% confidence interval, 1.07-2.07]), whereas independent risk factors for L-VAP vs E-VAP were older age (OR, 1.01 [1.01-1.02]), high Simplified Acute Physiology Score II (OR, 1.01 [1.00-1.02]), infection on admission (OR=2.22 [1.61-3.03]), another nosocomial infection before VAP (OR, 5.88 [3.33-11.11]), and exposure to central venous catheter before VAP (OR, 4.76 [1.04-20.00]). CONCLUSIONS: E-VAP and L-VAP have different risk factors, highlighting the need for developing specific preventive measures.

harmoni

目的：比较早发呼吸机相关肺炎和晚发呼吸机相关肺炎的风险因素。
方法：对法国里昂11所大学教学医院ICU内发生的医院感染的一项监测进行流行病学分析。监测1996年-2002年机械通气病人共7236人，年龄均大于18岁，入住ICU时间大于48小时。对患者相关独立危险因子、仪器设备暴露、医院感染发生及其结局相关数据进行收集。早发呼吸机相关肺炎(</=6 天)和晚发呼吸机相关肺炎(>6天) 界定点定于日呼吸机使用率。
结果：监测356（37.6%）例早发呼吸机相关肺炎和593（62.4%）例晚发呼吸机相关肺炎发病率13.1%。早发呼吸机相关肺炎相对于晚发呼吸机相关肺炎的独立危险因子为外科诊断种类（OR值为1.49【95%可信区间，1.07-2.07】），而晚发呼吸机相关肺炎相对于早发呼吸机相关肺炎的独立危险因子为年龄（OR值为 1.01 [1.01-1.02]), 较高的简化急性生理改变评分系统 II (OR, 1.01 [1.00-1.02]），感染入院（OR=2.22 [1.61-3.03]），VAP发生之前的其他医院感染(OR, 5.88 [3.33-11.11])，VAP发生前的中心静脉置管 (OR, 4.76 [1.04-20.00]。   
结论：早发和晚发呼吸机相关肺炎的风险因素各不相同，因此有必要采取不同的预防措施。

以和为贵

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