Zhang Yaowen, Yao Zhiyuan, Zhan Siyan, Yang Zhirong, Wei Dong, Zhang Jing, Li Jingyi, Kyaw Moe H
Infection Management and Disease Prevention Department, China-Japan Friendship Hospital, Beijing, P.R. China.
Department of Epidemiology and Bio-statistics, Peking University Health Science Center, Beijing, P.R. China.
Int J Infect Dis. 2014 Dec;29:84-90. doi: 10.1016/j.ijid.2014.05.030. Epub 2014 Oct 24.
Intensive care unit (ICU)-acquired pneumonia and ventilator-associated pneumonia (VAP) are associated with poor clinical and economic outcomes. Data regarding ICU-acquired pneumonia and VAP are not readily available from developing countries, including China. The objective of this meta-analysis was to evaluate the incidence, mortality rate, length of stay, and pathogens associated with ICU-acquired pneumonia in China.
A meta-analysis and systematic review of 334 publications published between January 2007 and May 2012 and retrieved from the Chinese BioMedical database, China National Knowledge Infrastructure, VIP Chinese Science and Technique Journals database, Wanfang database, and PubMed was conducted.
The incidences of ICU-acquired pneumonia and VAP were 16.2% (95% confidence interval (CI) 12.8-20.4%) and 33.7% (95% CI 31.4-36.1%), respectively; mortality rates were 37.4% (95% CI 24.6-52.2%) and 34.5% (95% CI 29.2-40.1%), respectively. The durations of stay in the ICU and hospital were 12.4 (95% CI 9.6-15.3) and 17.7 (95% CI 15.6-19.7) days and 18.0 (95% CI 16.5-19.6) and 30.5 (95% CI 26.4-34.7) days for ICU-acquired pneumonia and VAP, respectively. Pseudomonas aeruginosa (19.9%) and Acinetobacter baumannii (13.9%) were the most frequently isolated pathogens, followed by Klebsiella pneumoniae (11.9%) and Staphylococcus aureus (10.4%); 82.9% of S. aureus isolates were reported to be methicillin-resistant.
ICU-acquired pneumonia/VAP remains a major cause of morbidity and mortality in patients in the ICU in China. Data on organisms causing disease in this population could help guide appropriate prevention strategies and treatment.
重症监护病房（ICU）获得性肺炎和呼吸机相关性肺炎（VAP）与不良的临床和经济结局相关。包括中国在内的发展中国家，关于ICU获得性肺炎和VAP的数据不易获取。本荟萃分析的目的是评估中国ICU获得性肺炎的发病率、死亡率、住院时间及相关病原体。
对2007年1月至2012年5月期间发表的334篇出版物进行荟萃分析和系统评价，这些出版物来自中国生物医学数据库、中国知网、维普中文科技期刊数据库、万方数据库和PubMed。
ICU获得性肺炎和VAP的发病率分别为16.2%（95%置信区间[CI] 12.8 - 20.4%）和33.7%（95% CI 31.4 - 36.1%）；死亡率分别为37.4%（95% CI 24.6 - 52.2%）和34.5%（95% CI 29.2 - 40.1%）。ICU获得性肺炎和VAP患者在ICU和医院的住院时间分别为12.4（95% CI 9.6 - 15.3）天和17.7（95% CI 15.6 - 19.7）天，以及18.0（95% CI 16.5 - 19.6）天和30.5（95% CI 26.4 - 34.7）天。铜绿假单胞菌（19.9%）和鲍曼不动杆菌（13.9%）是最常分离出的病原体，其次是肺炎克雷伯菌（11.9%）和金黄色葡萄球菌（10.4%）；据报道，82.9%的金黄色葡萄球菌分离株对甲氧西林耐药。
在中国，ICU获得性肺炎/VAP仍然是ICU患者发病和死亡的主要原因。关于该人群致病微生物的数据有助于指导适当的预防策略和治疗。
