Martínez B, Gómez J, Gómez Vargas J, Gómez J R, Baños V, Sánchez M E, Canteras M, Valdés M
Servicio de Medicina Interna y Enfermedades Infecciosas, Murcia.
Rev Esp Quimioter. 2000 Jun;13(2):187-92.
Nosocomial pneumonia due to Gram-negative bacteria is one of the most important infections because of its high frequency, morbidity and mortality. The objective of this study was to determine the risk factors and prognosis for nosocomial pneumonia caused by Gram-negative bacteria. A group of 50 patients with nosocomial pneumonia due to Gram-negative bacteria were studied in a prospective, consecutive manner and compared with another group of 50 patients with similar characteristics but without infection. The diagnostic criteria, acquisition, previous infections, prognosis of the underlying disease, the initial severity of the clinical situation, presence of complications, type and evolution of antibiotic treatment were adjusted according to the criteria in the literature. Univariate and multivariate statistical analysis of the results was carried out. The risk factors found included the following: male sex, high-risk hospital units, nosocomial acquisition and previous manipulation with intubation and mechanical ventilation, previous pulmonary infections, and the use of wide-spectrum antibiotics in the six weeks prior to the study. The most isolated Gram-negative bacterium was Pseudomonas aeruginosa (32%), followed by polymicrobial flora (18%). Bacteriemia was found in 30% of the cases. Mortality was 24%, with the factors significantly associated with a poor prognosis being a serious underlying disease, a clinically critical situation, previous surgery, complications, Gram-negative bacteria, use of wide-spectrum antibiotics in the six months before the study, and advanced age. The mortality of the group was 8%. It was concluded that knowledge of the risk factors and prognosis of nosocomial pneumonia due to Gram-negative bacteria is of high importance to improve treatment and decrease morbidity and mortality.
革兰氏阴性菌所致医院获得性肺炎是最重要的感染之一，因其发生率高、发病率和死亡率高。本研究的目的是确定革兰氏阴性菌所致医院获得性肺炎的危险因素和预后。对一组50例革兰氏阴性菌所致医院获得性肺炎患者进行前瞻性、连续性研究，并与另一组50例具有相似特征但未感染的患者进行比较。根据文献标准调整诊断标准、感染获得情况、既往感染、基础疾病的预后、临床情况的初始严重程度、并发症的存在、抗生素治疗的类型和演变。对结果进行单因素和多因素统计分析。发现的危险因素包括：男性、高危医院科室、医院获得性感染以及既往插管和机械通气操作、既往肺部感染，以及研究前六周使用广谱抗生素。最常见的革兰氏阴性菌是铜绿假单胞菌（32%），其次是多菌丛（18%）。30%的病例出现菌血症。死亡率为24%，与预后不良显著相关的因素包括严重基础疾病、临床危急情况、既往手术、并发症、革兰氏阴性菌、研究前六个月使用广谱抗生素以及高龄。该组的死亡率为8%。得出的结论是，了解革兰氏阴性菌所致医院获得性肺炎的危险因素和预后对于改善治疗以及降低发病率和死亡率非常重要。
