Federal University of Rio Grande do Sul, School of Medicine, Department of Internal Medicine, Porto Alegre, Brazil.
J Bras Pneumol. 2013 May-Jun;39(3):339-48. doi: 10.1590/S1806-37132013000300011.
To identify risk factors for the development of hospital-acquired pneumonia (HAP) caused by multidrug-resistant (MDR) bacteria in non-ventilated patients.
This was a retrospective observational cohort study conducted over a three-year period at a tertiary-care teaching hospital. We included only non-ventilated patients diagnosed with HAP and presenting with positive bacterial cultures. Categorical variables were compared with chi-square test. Logistic regression analysis was used to determine risk factors for HAP caused by MDR bacteria.
Of the 140 patients diagnosed with HAP, 59 (42.1%) were infected with MDR strains. Among the patients infected with methicillin-resistant Staphylococcus aureus and those infected with methicillin-susceptible S. aureus, mortality was 45.9% and 50.0%, respectively (p = 0.763). Among the patients infected with MDR and those infected with non-MDR gram-negative bacilli, mortality was 45.8% and 38.3%, respectively (p = 0.527). Univariate analysis identified the following risk factors for infection with MDR bacteria: COPD; congestive heart failure; chronic renal failure; dialysis; urinary catheterization; extrapulmonary infection; and use of antimicrobial therapy within the last 10 days before the diagnosis of HAP. Multivariate analysis showed that the use of antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria (OR = 3.45; 95% CI: 1.56-7.61; p = 0.002).
In this single-center study, the use of broad-spectrum antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria in non-ventilated patients with HAP.
确定非机械通气患者发生多重耐药（MDR）菌医院获得性肺炎（HAP）的危险因素。
这是一项为期三年的回顾性观察性队列研究，在一家三级教学医院进行。我们仅纳入诊断为 HAP 且细菌培养阳性的非机械通气患者。采用卡方检验比较分类变量。采用 logistic 回归分析确定 MDR 细菌引起 HAP 的危险因素。
在 140 例诊断为 HAP 的患者中，59 例（42.1%）感染了 MDR 菌株。耐甲氧西林金黄色葡萄球菌和甲氧西林敏感金黄色葡萄球菌感染者的死亡率分别为 45.9%和 50.0%（p = 0.763）。MDR 感染和非 MDR 革兰氏阴性杆菌感染者的死亡率分别为 45.8%和 38.3%（p = 0.527）。单因素分析确定了感染 MDR 细菌的以下危险因素：COPD；充血性心力衰竭；慢性肾功能衰竭；透析；导尿；肺外感染；以及在 HAP 诊断前 10 天内使用抗菌药物治疗。多因素分析显示，在 HAP 诊断前 10 天内使用抗生素是感染 MDR 细菌的唯一独立预测因素（OR = 3.45；95%CI：1.56-7.61；p = 0.002）。
在这项单中心研究中，在 HAP 诊断前 10 天内使用广谱抗生素是 HAP 非机械通气患者感染 MDR 细菌的唯一独立预测因素。
