Intensive Care Unit, Faculty of Medicine, University of Sfax, Hôpital Habib Bourguiba, Route el Ain Km 1, 3029 Sfax, Tunisia.
Int J Infect Dis. 2013 Dec;17(12):e1225-8. doi: 10.1016/j.ijid.2013.07.014. Epub 2013 Sep 11.
The aim of this study was to describe the epidemiological characteristics of Acinetobacter baumannii ventilator-associated pneumonia (VAP) and to identify factors predictive of a poor outcome.
A retrospective study was conducted over 16 months in a Tunisian intensive care unit (ICU). All adult patients with A. baumannii VAP were included.
Ninety-two patients were included in they study; 41 (44.6%) were admitted because of multiple trauma. The mean age of the patients was 44.5±19.5 years. All patients needed mechanical ventilation on admission. The mean SAPS II score was 39±15. The mean delay before VAP onset was 8.1±4.7 days. On VAP onset, 57 patients (62%) developed septic shock. Only 14.2% of isolated strains were susceptible to imipenem; none were resistant to colistin. The mean duration of mechanical ventilation was 20±11 days. The mean duration of ICU stay was 24.3±18.7 days. ICU mortality was 60.9%. In the multivariate analysis, factors predictive of a poor outcome were previously known hypertension (odds ratio 5.8, 95% confidence interval 1.4-24.9; p=0.018) and VAP-related septic shock (odds ratio 8.5, 95% confidence interval 3-23.7; p<0.001).
A. baumannii VAP is associated with a high mortality. Hemodynamic impairment is predictive of a poor outcome.
本研究旨在描述鲍曼不动杆菌呼吸机相关性肺炎（VAP）的流行病学特征，并确定预后不良的预测因素。
在突尼斯的一个重症监护病房（ICU）进行了为期 16 个月的回顾性研究。所有鲍曼不动杆菌 VAP 成年患者均被纳入研究。
共有 92 例患者纳入研究，其中 41 例（44.6%）因多发伤入院。患者的平均年龄为 44.5±19.5 岁。所有患者入院时均需机械通气。SAPS II 评分的平均值为 39±15。VAP 发病前的平均时间为 8.1±4.7 天。VAP 发病时，57 例患者（62%）发生感染性休克。只有 14.2%的分离株对亚胺培南敏感；无耐药菌株对粘菌素耐药。机械通气的平均持续时间为 20±11 天。ICU 住院的平均时间为 24.3±18.7 天。ICU 死亡率为 60.9%。在多变量分析中，预后不良的预测因素包括既往已知的高血压（比值比 5.8，95%置信区间 1.4-24.9；p=0.018）和与 VAP 相关的感染性休克（比值比 8.5，95%置信区间 3-23.7；p<0.001）。
鲍曼不动杆菌 VAP 死亡率较高。血流动力学障碍是预后不良的预测因素。
