巴西一家大学医院重症监护病房的医院获得性肺炎：入院至发病时间跨度分析

Gusmão Maria Enoy Neves, Dourado Inês, Fiaccone Rosimeire Leovigildo

Federal University of Bahia.

Am J Infect Control. 2004 Jun;32(4):209-14. doi: 10.1016/j.ajic.2003.11.003.

BACKGROUND

In addition to controversies as to the definition of nosocomial pneumonia (NP) because of the lack of a widely accepted diagnostic standard, there has been no agreement concerning the time span from hospital admission to disease onset. This study aims at both estimating the time span, in hours, from admission to the occurrence of suspected NP and investigating risk factors that might influence this time span.

METHODS

This is a cohort study, and subjects were patients with nosocomial infection acquired in the intensive care unit of Edgard Santos University Hospital (HUPES/ICU) in Salvador, Brazil, from January 1995 to December 1997. Patients were observed from admission to 48 hours after discharge from the intensive care unit. The time span from admission to occurrence of suspected NP, the reason for admission, patient's origin, history of surgery, general anesthesia, mechanical ventilation, and use of antibiotic were analyzed and given a multivariate analysis using Cox regression model.

RESULTS

Among 246 patients with nosocomial infection, 198 (80.5%) were suspected cases of NP, whereas 48 patients (19.5%) were not classified as such. The mean time, in hours, for the NP-free time span was 85.1 +/- 3.5 hours, and the median time was 72 hours when estimated by Kaplan-Meier method. Patients admitted from surgical heart procedures who had been given general anesthesia, mechanical ventilation, and antibiotics showed statistically significant shorter mean time spans from admission to NP occurrence when compared with the other patients. Age >or=50 years, use of mechanical ventilation, and use of antibiotics were associated with NP.

CONCLUSIONS

Our finding for the estimated mean NP-free time span at the HUPES/ICU is somewhat in accordance with the literature (48 to 72 hours). Patients at HUPES/ICU might be considered as showing early NP, because they were diagnosed before the 5th day after admission. Preventive measures to NP should be reviewed and intensified at the HUPES/ICU, especially as related to mechanical ventilation.

背景

由于缺乏广泛接受的诊断标准，医院获得性肺炎（NP）的定义存在争议，而且对于从入院到发病的时间跨度也没有达成共识。本研究旨在估计从入院到疑似NP发生的时间跨度（以小时为单位），并调查可能影响这一时间跨度的危险因素。

方法

这是一项队列研究，研究对象为1995年1月至1997年12月在巴西萨尔瓦多的埃德加德·桑托斯大学医院重症监护病房（HUPES/ICU）获得医院感染的患者。从入院开始观察患者，直至其从重症监护病房出院后48小时。分析从入院到疑似NP发生的时间跨度、入院原因、患者来源、手术史、全身麻醉、机械通气及抗生素使用情况，并使用Cox回归模型进行多变量分析。

结果

在246例医院感染患者中，198例（80.5%）为疑似NP病例，而48例患者（19.5%）未被归类为此类。通过Kaplan-Meier法估计，无NP时间跨度的平均时间为85.1±3.5小时，中位数时间为72小时。与其他患者相比，接受心脏外科手术、接受全身麻醉、机械通气及抗生素治疗的患者从入院到NP发生的平均时间跨度在统计学上显著较短。年龄≥50岁、使用机械通气及使用抗生素与NP相关。