Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Infect Control Hosp Epidemiol. 2009 Dec;30(12):1193-202. doi: 10.1086/648455.
The aim of this study was to determine potential risk factors for mortality in patients with nosocomial Stenotrophomonas maltophilia pneumonia.
A retrospective, single-center, observational study.
A 2400-bed tertiary teaching hospital in southern Taiwan.
This retrospective study evaluated patients (age, at least 18 years) with nosocomial pneumonia (S. maltophilia isolated from respiratory culture) who were seen at Kaohsiung Chang Gung Memorial Hospital over a 3-year period. A total of 406 patients (64% male, mean age +/- standard deviation, 69.6 +/- 14.93 years; mean duration of hospital +/- standard deviation, 57.5 +/- 39.47 days) were included.
Most index isolates (53.9%) were from the first sample cultured. Polymicrobial isolates were cultured from samples from 177 (43.6%) of the 406 study patients. The most common copathogen was Pseudomonas aeruginosa (53.11% of isolates). The all-cause hospital mortality rate was 42.6% (173 deaths among 406 patients). Survivors had a shorter time from admission to a positive index culture result than did nonsurvivors (26.1 vs 31.7 days; P = .04). Mortality was significantly higher among patients with malignancy (adjusted odds ratio [AOR], 2.48; 95% confidence interval [CI], 1.52-4.07; P < .001), renal disease (AOR, 2.6; 95% CI, 1.51-4.47; P = .001), intensive care unit stay (AOR, 1.72; 95% CI, 1.1-2.7; P = .018), and inadequate initial empirical antibiotic therapy (AOR, 2.17; 95% CI, 1.4-3.38; P = .001).
S. maltophilia pneumonia is associated with a high mortality rate and is commonly associated with concomitant polymicrobial colonization or infection. Underlying comorbidities and inadequate initial empirical antibiotic therapy substantially account for increased mortality rates.
本研究旨在确定医院获得性嗜麦芽窄食单胞菌肺炎患者死亡的潜在危险因素。
回顾性、单中心、观察性研究。
中国台湾南部的一家 2400 张床位的三级教学医院。
这项回顾性研究评估了在高雄长庚纪念医院就诊的 3 年内患有医院获得性肺炎（嗜麦芽窄食单胞菌从呼吸道培养物中分离）的患者（年龄至少 18 岁）。共纳入 406 例患者（64%为男性，平均年龄 +/- 标准差，69.6 +/- 14.93 岁；平均住院时间 +/- 标准差，57.5 +/- 39.47 天）。
大多数指数分离株（53.9%）来自第一次培养的样本。406 例研究患者的样本中培养出了多种微生物分离株。最常见的共病原体是铜绿假单胞菌（53.11%的分离株）。全因住院死亡率为 42.6%（406 例患者中有 173 例死亡）。幸存者从入院到阳性指数培养结果的时间比非幸存者短（26.1 天对 31.7 天；P =.04）。恶性肿瘤（调整后的优势比 [AOR]，2.48；95%置信区间 [CI]，1.52-4.07；P <.001）、肾脏疾病（AOR，2.6；95% CI，1.51-4.47；P =.001）、重症监护病房（AOR，1.72；95% CI，1.1-2.7；P =.018）和初始经验性抗生素治疗不足（AOR，2.17；95% CI，1.4-3.38；P =.001）的患者死亡率显著更高。
嗜麦芽窄食单胞菌肺炎与高死亡率相关，常与同时发生的多微生物定植或感染相关。潜在的合并症和初始经验性抗生素治疗不足极大地导致了死亡率的增加。
