多重耐药铜绿假单胞菌引起的呼吸机相关肺炎：流行，发病和风险因素

David

Journal of Critical Care
Volume 23, Issue 1, March 2008, Pages 18-26

Theme Issue Editorial
Ventilator-associated pneumonia caused by multidrug-resistant organisms or Pseudomonas aeruginosa: Prevalence, incidence, risk factors, and outcomes
多重耐药铜绿假单胞菌引起的呼吸机相关肺炎：流行，发病和风险因素
Chris M. Parker MD, MSca, Jim Kutsogiannis MD, MHSb, John Muscedere MDa, Deborah Cook MD, MScc, Peter Dodek MD, MHScd, Andrew G. Day MSce, Daren K. Heyland MD, MSca, e, ,  and for the Canadian Critical Care Trials Group
aDepartment of Medicine, Queen's University, Kingston, Ontario, Canada K7L 2V7
bDepartment of Critical Care, University of Alberta, Edmonton, Alberta, Canada T6G 2R3
cClinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada L8N 3Z5
dCenter for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada V6Z 1Y6
eClinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada K7L 2V7

Available online 20 March 2008.
Abstract
Purpose
The aim of this study was to clarify the prevalence and incidence of, risk factors for, and outcomes from suspected ventilator-associated pneumonia (VAP) associated with the isolation of either Pseudomonas or multidrug-resistant (MDR) bacteria (“high risk” pathogens) from respiratory secretions.

Materials and Methods
Data were collected as part of a large, multicentered trial of diagnostic and therapeutic strategies for patients (n = 739) with suspected VAP.

Results
At enrollment, 6.4% of patients had Pseudomonas species, and 5.1% of patients had at least 1 MDR organism isolated from respiratory secretions. Over the study period, the incidence of Pseudomonas and MDR organisms was 13.4% and 9.2%, respectively. Independent risk factors for the presence of these pathogens at enrollment were duration of hospital stay ≥48 hours before intensive care unit (ICU) admission (odds ratio, 2.37 [95% CI, 1.40-4.02]; P = .001] and prolonged duration of ICU stay before enrollment (odds ratio, 1.50 [95% CI, 1.17-1.93]; P = .002] per week. Fewer patients whose specimens grew either Pseudomonas or MDR organisms received appropriate empirical antibiotic therapy compared to those without these pathogens (68.5% vs 93.9%, P < .001). The isolation of high risk pathogens from respiratory secretions was associated with higher 28-day (relative risk, 1.59 [95% CI, 1.07-2.37]; P = .04] and hospital mortality (relative risk, 1.48 [95% CI, 1.05-2.07]; P = .05), and longer median duration of mechanical ventilation (12.6 vs 8.7 days, P = .05), ICU length of stay (16.2 vs 12.0 days, P = .05), and hospital length of stay (55.0 vs 41.8 days, P = .05).

Conclusions
In this patient population, the incidence of high-risk organisms newly acquired during an ICU stay is low. However, the presence of high risk pathogens is associated with worse clinical outcomes.

Keywords: Ventilator-associated pneumonia; ICU outcomes; Pseudomonas aeruginosa

麦苗

谢DAVID提供:我翻译了一下摘要:
目的：
本研究欲阐明从呼吸道分泌物中分离到假单胞菌或多重耐药菌（高致病菌）怀疑是VAP感染病人的现患率、发病率，危险因素和预后。
材料和方法：
收集疑似VAP感染的739个病人资料，是一个大型多中心临床诊断治疗实验的一部分。
结果：
6.4%入院病人从呼吸道分泌物中分离出假单胞菌，5.1%病人分离出至少1种MDR。研究期内，假单胞菌和MDR的发病率分别为13.4% 和 9.2%。在入院病人中，这些病原菌感染的危险因素包括进入ICU病房前在医院住院时间超过48小时，OR=2.37 [95% CI, 1.40-4.02]，P = 0.001，ICU期间延长OR=1.50 [95% CI, 1.17-1.93]，P =0 .002。与没有感染的病人相比，感染假单胞菌或MDR的人中只有很少人接受过恰当的抗生素治疗(68.5% vs 93.9%, P < .001)。从呼吸道分泌物中分离的高危险致病菌与高住院天数28天(RR=1.59 [95% CI, 1.07-2.37] ， P =0 .04，医院病死率(RR=1.48 [95% CI, 1.05-2.07]; P =0 .05)，长时间机械通气（12.6 vs 8.7 天, P =0 .05)，ICU时间(16.2 vs 12.0 days, P =0 .05)，住院时间(55.0 vs 41.8 days, P =0.05).有关。
结论：
本研究病人中，在ICU新发高危险致病菌感染率低，但是感染高危险致病菌与较差的临床预后有关。
关键词：呼吸机相关肺炎，ICU预后；铜绿假单胞菌