Chenoweth Carol E, Washer Laraine L, Obeyesekera Kumari, Friedman Candace, Brewer Karolyn, Fugitt Garrett E, Lark Rebecca
Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, MI 48109, USA.
Infect Control Hosp Epidemiol. 2007 Aug;28(8):910-5. doi: 10.1086/519179. Epub 2007 Jun 14.
To describe the rate of infection, associated organisms, and potential risk factors for ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation at home.
Retrospective cohort study.
University-affiliated home care service.
Patients receiving mechanical ventilation at home from June 1995 through December 2001.
Fifty-seven patients underwent ventilation at home for a total of 50,762 ventilator-days (mean +/- SD, 890.6 +/- 644.43 days; range, 76-2,458 days). Seventy-nine episodes of VAP occurred in 27 patients (rate, 1.55 episodes per 1,000 ventilator-days). The first episode of VAP occurred after a mean (+/-SD) of 245 +/- 318.07 ventilator-days. VAP was most common during the first 500 days of ventilation. Rates of VAP were higher among patients who required ventilation for longer daily durations, compared with those who required it for shorter daily durations. There was no association of VAP with age, sex, underlying disease, reason for ventilation, antacid therapy, or steroid use. Microorganisms isolated from 33 episodes of VAP with available culture results included Pseudomonas species (17 isolates), Staphylococcus aureus (11), Serratia species (7), and Stenotrophomonas species (5). Eight patients died during the study; no deaths were attributed to pneumonia.
Although the organisms associated with VAP in the home setting are similar to those associated with hospital-acquired VAP, the incidence and mortality is much lower in the home care setting. Interventions to reduce the risk of VAP among patients receiving home care should be focused on patients who require ventilation for longer daily durations or who are new to receiving mechanical ventilation at home.
描述在家接受机械通气患者的呼吸机相关性肺炎（VAP）感染率、相关病原体及潜在危险因素。
回顾性队列研究。
大学附属医院家庭护理服务机构。
1995年6月至2001年12月在家接受机械通气的患者。
57例患者在家接受通气治疗，累计通气天数达50762天（平均±标准差，890.6±644.43天；范围，76 - 2458天）。27例患者发生79次VAP发作（发生率为每1000个通气日1.55次发作）。VAP首次发作发生在平均（±标准差）245±318.07个通气日后。VAP在通气的前500天最为常见。与每日通气时间较短的患者相比，每日通气时间较长的患者VAP发生率更高。VAP与年龄、性别、基础疾病、通气原因、抗酸治疗或类固醇使用无关。从33次有可用培养结果的VAP发作中分离出的微生物包括假单胞菌属（17株分离菌）、金黄色葡萄球菌（11株）、沙雷菌属（7株）和嗜麦芽窄食单胞菌属（5株）。8例患者在研究期间死亡；无死亡归因于肺炎。
虽然在家中发生VAP所涉及的病原体与医院获得性VAP相关病原体相似，但家庭护理环境中的发病率和死亡率要低得多。降低接受家庭护理患者VAP风险的干预措施应侧重于每日通气时间较长或刚开始在家接受机械通气的患者。
