Mentzelopoulos Spyros D, Pratikaki Maria, Platsouka Evangelia, Kraniotaki Helen, Zervakis Dimitris, Koutsoukou Antonia, Nanas Serafim, Paniara Olga, Roussos Charis, Giamarellos-Bourboulis Evangelos, Routsi Christina, Zakynthinos Spyros G
University of Athens Medical School, First Department of Critical Care, 45-47 Ipsilandou Street, GR-10675 Athens, Greece.
Intensive Care Med. 2007 Sep;33(9):1524-32. doi: 10.1007/s00134-007-0683-2. Epub 2007 Jun 5.
We present our experience with five cases of pandrug-resistant Pseudomonas aeruginosa ventilator-associated pneumonia (VAP) and analysis of risk factors.
Case-control study in a 15-bed intensive care unit (ICU).
The study included 5 cases and 20 controls. Each case patient was matched to four contemporary controls according to gender, prior hospital admissions, hospitalization duration, ICU admission cause, Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Function Assessment (SOFA) scores on ICU admission, and length of ICU stay, and mechanical ventilation duration until first VAP episode by a multidrug-resistant bacterium.
Recorded variables included age, gender, daily APACHE II and SOFA scores, patient medication, treatment interventions, positive cultures and corresponding antibiograms, occurrence of infection, sepsis, and septic shock, other ICU-associated morbidity, length of ICU stay and mechanical ventilation, and patient outcome. Healthcare worker and environmental cultures, and a hand-disinfection survey were performed. Pandrug-resistant P. aeruginosa isolates belonged to the same genotype and were bla (VIM-1)-like gene positive. The outbreak resolved following reinforcement of infection-control measures (September 27). The sole independent predictor for pandrug-resistant P. aeruginosa VAP was combined use of carbapenem for more than 20 days and colistin use for and more than 13 days (odds ratio 76.0; 95% confidence interval 3.7-1487.6). An additional risk factor was more than 78 open suctioning procedures during 6-26 September (odds ratio 16.0; 95% confidence interval 1.4-185.4).
Prolonged carbapenem-colistin use predisposes to VAP by pandrug-resistant P. aeruginosa. Cross-transmission may be facilitated by open suctioning.
我们介绍5例泛耐药铜绿假单胞菌呼吸机相关性肺炎（VAP）的治疗经验及危险因素分析。
在一个拥有15张床位的重症监护病房（ICU）进行病例对照研究。
该研究纳入5例病例和20例对照。根据性别、既往住院史、住院时间、入住ICU原因、入住ICU时的急性生理与慢性健康状况评分系统（APACHE）Ⅱ及序贯器官功能评估（SOFA）评分、ICU住院时间以及直至首次发生由多重耐药菌引起的VAP时的机械通气时间，为每例病例患者匹配4例同时期对照。
记录的变量包括年龄、性别、每日APACHEⅡ和SOFA评分、患者用药情况、治疗干预措施、阳性培养结果及相应的抗菌谱、感染、脓毒症和感染性休克的发生情况、其他与ICU相关的发病率、ICU住院时间和机械通气时间以及患者结局。进行了医护人员和环境培养以及手部消毒调查。泛耐药铜绿假单胞菌分离株属于同一基因型，且bla（VIM-1）样基因呈阳性。在强化感染控制措施后（9月27日）疫情得到控制。泛耐药铜绿假单胞菌VAP的唯一独立预测因素是碳青霉烯类药物联合使用超过20天以及多黏菌素使用超过13天（比值比76.0；95%置信区间3.7-1487.6）。另一个危险因素是9月6日至26日期间进行了超过78次开放式吸痰操作（比值比16.0；95%置信区间1.4-185.4）。
长期使用碳青霉烯类药物和多黏菌素易引发泛耐药铜绿假单胞菌所致的VAP。开放式吸痰可能会促进交叉传播。
