抗菌药物耐药性和老龄化对呼吸机相关性肺炎结局的影响：来自一家大型三级护理中心的经验
The impact of antimicrobial resistance and aging in VAP outcomes: experience from a large tertiary care center.
作者信息
Arvanitis Marios, Anagnostou Theodora, Kourkoumpetis Themistoklis K, Ziakas Panayiotis D, Desalermos Athanasios, Mylonakis Eleftherios
机构信息
Department of Medicine, Infectious Diseases Division, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America ; Department of Medicine, Infectious Disease Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
Department of Medicine, Infectious Disease Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
出版信息
PLoS One. 2014 Feb 27;9(2):e89984. doi: 10.1371/journal.pone.0089984. eCollection 2014.
BACKGROUND
Ventilator associated pneumonia (VAP) is a serious infection among patients in the intensive care unit (ICU).
METHODS
We reviewed the medical charts of all patients admitted to the adult intensive care units of the Massachusetts General Hospital that went on to develop VAP during a five year period.
RESULTS
200 patients were included in the study of which 50 (25%) were infected with a multidrug resistant pathogen. Increased age, dialysis and late onset (≥ 5 days from admission) VAP were associated with increased incidence of resistance. Multidrug resistant bacteria (MDRB) isolation was associated with a significant increase in median length of ICU stay (19 vs. 16 days, p=0.02) and prolonged duration of mechanical ventilation (18 vs. 14 days, p=0.03), but did not impact overall mortality (HR 1.12, 95% CI 0.51-2.46, p=0.77). However, age (HR 1.04 95% CI 1.01-1.07, p=0.003) was an independent risk factor for mortality and age ≥ 65 years was associated with increased incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections (OR 2.83, 95% CI 1.27-6.32, p=0.01).
CONCLUSIONS
MDRB-related VAP is associated with prolonged ICU stay and mechanical ventilation. Interestingly, age ≥ 65 years is associated with MRSA VAP.
背景
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）患者中一种严重的感染。
方法
我们回顾了麻省总医院成人重症监护病房在五年期间所有发生VAP的患者的病历。
结果
200例患者纳入研究，其中50例（25%）感染了多重耐药病原体。年龄增加、透析以及晚发性（入院≥5天）VAP与耐药发生率增加相关。多重耐药菌（MDRB）分离与ICU住院时间中位数显著增加（19天对16天，p=0.02）以及机械通气时间延长（18天对14天，p=0.03）相关，但不影响总体死亡率（风险比1.12，95%置信区间0.51-2.46，p=0.77）。然而，年龄（风险比1.04，95%置信区间1.01-1.07，p=0.003）是死亡率的独立危险因素，年龄≥65岁与耐甲氧西林金黄色葡萄球菌（MRSA）感染发生率增加相关（比值比2.83，95%置信区间1.27-6.32，p=0.01）。
结论
与MDRB相关的VAP与ICU住院时间延长和机械通气时间延长相关。有趣的是，年龄≥65岁与MRSA VAP相关。
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