Harris Anthony D, Jackson Sarah S, Robinson Gwen, Pineles Lisa, Leekha Surbhi, Thom Kerri A, Wang Yuan, Doll Michelle, Pettigrew Melinda M, Johnson J Kristie
1University of Maryland School of Medicine,Baltimore,Maryland.
2Yale School of Public Health,New Haven,Connecticut.
Infect Control Hosp Epidemiol. 2016 May;37(5):544-8. doi: 10.1017/ice.2015.346. Epub 2016 Feb 1.
To determine the prevalence of Pseudomonas aeruginosa colonization on intensive care unit (ICU) admission, risk factors for P. aeruginosa colonization, and the incidence of subsequent clinical culture with P. aeruginosa among those colonized and not colonized.
We conducted a cohort study of patients admitted to a medical or surgical intensive care unit of a tertiary care hospital. Patients had admission perirectal surveillance cultures performed. Risk factors analyzed included comorbidities at admission, age, sex, antibiotics received during current hospitalization before ICU admission, and type of ICU.
Of 1,840 patients, 213 (11.6%) were colonized with P. aeruginosa on ICU admission. Significant risk factors in the multivariable analysis for colonization were age (odds ratio, 1.02 [95% CI, 1.01-1.03]), anemia (1.90 [1.05-3.42]), and neurologic disorder (1.80 [1.27-2.54]). Of the 213 patients colonized with P. aeruginosa on admission, 41 (19.2%) had a subsequent clinical culture positive for P. aeruginosa on ICU admission and 60 (28.2%) had a subsequent clinical culture positive for P. aeruginosa in the current hospitalization (ICU period and post-ICU period). Of these 60 patients, 49 (81.7%) had clinical infections. Of the 1,627 patients not colonized on admission, only 68 (4.2%) had a subsequent clinical culture positive for P. aeruginosa in the current hospitalization. Patients colonized with P. aeruginosa were more likely to have a subsequent positive clinical culture than patients not colonized (incidence rate ratio, 6.74 [95% CI, 4.91-9.25]).
Prediction rules or rapid diagnostic testing will help clinicians more appropriately choose empirical antibiotic therapy for subsequent infections.
确定重症监护病房（ICU）入院时铜绿假单胞菌定植的患病率、铜绿假单胞菌定植的危险因素，以及在定植和未定植患者中随后临床培养出铜绿假单胞菌的发生率。
我们对一家三级医院内科或外科重症监护病房收治的患者进行了一项队列研究。患者入院时进行了直肠周围监测培养。分析的危险因素包括入院时的合并症、年龄、性别、ICU入院前当前住院期间接受的抗生素以及ICU类型。
在1840例患者中，213例（11.6%）在ICU入院时被铜绿假单胞菌定植。多变量分析中定植的显著危险因素为年龄（比值比，1.02[95%可信区间，1.01 - 1.03]）、贫血（1.90[1.05 - 3.42]）和神经系统疾病（1.80[1.27 - 2.54]）。在入院时被铜绿假单胞菌定植的213例患者中，41例（19.2%）在ICU入院时随后的临床培养铜绿假单胞菌呈阳性，60例（28.2%）在当前住院期间（ICU期间和ICU后期间）随后的临床培养铜绿假单胞菌呈阳性。在这60例患者中，49例（81.7%）有临床感染。在1627例入院时未定植的患者中，只有68例（4.2%）在当前住院期间随后的临床培养铜绿假单胞菌呈阳性。与未定植患者相比，被铜绿假单胞菌定植的患者随后临床培养呈阳性的可能性更大（发病率比，6.74[95%可信区间，4.91 - 9.25]）。
预测规则或快速诊断检测将有助于临床医生更恰当地选择针对后续感染的经验性抗生素治疗。
