Weber David J, Rutala William A, Sickbert-Bennett Emily E, Samsa Gregory P, Brown Vickie, Niederman Michael S
Department of Hospital Epidemiology, University of North Carolina Health Care System, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA.
Infect Control Hosp Epidemiol. 2007 Jul;28(7):825-31. doi: 10.1086/518460. Epub 2007 May 17.
Nosocomial pneumonia is the leading cause of mortality attributed to nosocomial infection. Appropriate empirical therapy has been associated with improved survival, but data are limited regarding the etiologic agents of hospital-acquired pneumonia in nonventilated patients (HAP). This evaluation assessed whether the currently recommended empirical therapy is appropriate for both ventilator-associated pneumonia (VAP) and HAP by evaluating the infecting flora.
Prospectively collected hospitalwide surveillance data was obtained by infection control professionals using standard Centers for Disease Control and Prevention definitions.
A tertiary care academic hospital.
All patients admitted from 2000 through 2003.
A total of 588 episodes of pneumonia were reported in 556 patients: 327 episodes of VAP in 309 patients, and 261 episodes of HAP in 247 patients. The infecting flora in ventilated patients included gram-positive cocci (32.0% [oxacillin-susceptible Staphylococcus aureus {OSSA}, 9.25%; oxacillin-resistant Staphylococcus aureus {ORSA}, 17.75%]), gram-negative bacilli (59.0% (Pseudomonas aeruginosa, 17.50%; Stenotrophomonas maltophilia, 6.75%; Acinetobacter species, 7.75%), and miscellaneous pathogens (9.0%). The infecting flora in nonventilated patients included gram-positive cocci (42.59% [OSSA, 13.33%; ORSA, 20.37%]), gram-negative bacilli (39.63% [P. aeruginosa, 9.26%; S. maltophilia, 1.11%; Acinetobacter species, 3.33%), and miscellaneous pathogens (17.78%).
Our data demonstrated that patients with HAP, compared with those with VAP, had a similar frequency of infection with ORSA but less commonly had infections due to P. aeruginosa, Acinetobacter species, and S. maltophilia. However, the overall frequency of infection with these pathogens was sufficiently high to warrant the use of empirical therapy likely to be active against them. Our data supports using the currently recommended empirical therapy for both HAP and VAP.
医院获得性肺炎是医院感染导致死亡的主要原因。恰当的经验性治疗与生存率提高相关，但关于非机械通气患者医院获得性肺炎（HAP）的病原体的数据有限。本评估通过评估感染菌群来判断当前推荐的经验性治疗是否适用于呼吸机相关性肺炎（VAP）和HAP。
感染控制专业人员使用美国疾病控制与预防中心的标准定义前瞻性收集全院监测数据。
一家三级医疗学术医院。
2000年至2003年期间收治的所有患者。
556例患者共报告了588例肺炎发作：309例患者发生327例VAP，247例患者发生261例HAP。机械通气患者的感染菌群包括革兰氏阳性球菌（32.0%[对苯唑西林敏感的金黄色葡萄球菌{OSSA}，9.25%；耐苯唑西林金黄色葡萄球菌{ORSA}，17.75%]）、革兰氏阴性杆菌（59.0%[铜绿假单胞菌，17.50%；嗜麦芽窄食单胞菌，6.75%；不动杆菌属，7.75%]）和其他病原体（9.0%）。非机械通气患者的感染菌群包括革兰氏阳性球菌（42.59%[OSSA，13.33%；ORSA，20.37%]）、革兰氏阴性杆菌（39.63%[铜绿假单胞菌，9.26%；嗜麦芽窄食单胞菌，1.11%；不动杆菌属，3.33%]）和其他病原体（17.78%）。
我们的数据表明，与VAP患者相比，HAP患者感染ORSA的频率相似，但感染铜绿假单胞菌、不动杆菌属和嗜麦芽窄食单胞菌的情况较少见。然而，这些病原体的总体感染频率足够高，有必要使用可能对它们有效的经验性治疗。我们的数据支持对HAP和VAP均使用当前推荐的经验性治疗。
