Hyllienmark Petra, Martling Claes-Roland, Struwe Johan, Petersson Johan
Department of Anaesthesiology and Intensive Care, Karolinska University Hospital Solna, Stockholm, Sweden.
Scand J Infect Dis. 2012 Jun;44(6):444-52. doi: 10.3109/00365548.2011.645504. Epub 2012 Feb 13.
Ventilator-associated pneumonia (VAP), the most common hospital-acquired infection in intensive care unit (ICU) patients, is caused by bacteria in the lower respiratory tract of mechanically ventilated patients.
The current study was focused on 443 bacterial isolates from the lower respiratory tract of mechanically ventilated ICU patients (n = 346) in a Swedish University Hospital. Data were obtained from a prospective infection control database covering 9 y (2002-2010). We analysed the correlation between duration of hospital care and mechanical ventilation at the time of sampling on the occurrence of different pathogens.
Duration of hospital care and mechanical ventilation prior to sampling was similarly short for Streptococcus pneumoniae, beta-streptococci, and Haemophilus influenzae (≤ 2 days). In contrast, duration of hospital care and mechanical ventilation were longest for Stenotrophomonas maltophilia (6 and 11 days). For Staphylococcus aureus, the most common Gram-positive isolate, the duration was longer than for S. pneumoniae but shorter than for most Gram-negative bacteria. With the exception of S. maltophilia and Pseudomonas aeruginosa, the median duration of mechanical ventilation was short and similar for most bacteria. In samples taken on the first day of mechanical ventilation, the rate of pathogens expected to be resistant to cefotaxime was 23%.
The occurrence of pathogens with high antibiotic resistance in the lower respiratory tract increases with increased duration of hospital care and mechanical ventilation. An equally important result is that pathogens resistant to third-generation cephalosporins were more common than expected, even after a very short duration of hospital care and mechanical ventilation.
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）患者中最常见的医院获得性感染，由机械通气患者下呼吸道中的细菌引起。
本研究聚焦于瑞典一家大学医院中机械通气的ICU患者（n = 346）下呼吸道的443株细菌分离株。数据来自一个涵盖9年（2002 - 2010年）的前瞻性感染控制数据库。我们分析了采样时的住院时间和机械通气时间与不同病原体发生之间的相关性。
肺炎链球菌、β - 链球菌和流感嗜血杆菌采样前的住院时间和机械通气时间同样较短（≤2天）。相比之下，嗜麦芽窄食单胞菌的住院时间和机械通气时间最长（分别为6天和11天）。对于最常见的革兰氏阳性分离株金黄色葡萄球菌，其持续时间比肺炎链球菌长，但比大多数革兰氏阴性菌短。除嗜麦芽窄食单胞菌和铜绿假单胞菌外，大多数细菌的机械通气中位持续时间较短且相似。在机械通气第一天采集的样本中，预期对头孢噻肟耐药的病原体比例为23%。
下呼吸道中高耐药性病原体的发生率随住院时间和机械通气时间的增加而升高。同样重要的一个结果是，即使在住院时间和机械通气时间非常短之后，对第三代头孢菌素耐药的病原体也比预期更常见。
