Micek Scott T, Chew Bethany, Hampton Nicholas, Kollef Marin H
St. Louis College of Pharmacy, Department of Pharmacy Practice, St. Louis, MO.
St. Louis College of Pharmacy, Department of Pharmacy Practice, St. Louis, MO.
Chest. 2016 Nov;150(5):1008-1014. doi: 10.1016/j.chest.2016.04.009. Epub 2016 Apr 19.
Nonventilated hospital-acquired pneumonia (NVHAP) is a serious nosocomial infection that is increasingly attributed to antibiotic-resistant bacteria.
This is a retrospective case-control study comparing patients with and those without NVHAP from January 1, 2014 to December 31, 2014 at Barnes-Jewish Hospital, a 1,300-bed urban academic medical center in St. Louis, Missouri.
One hundred seventy-four consecutive patients with NVHAP were enrolled. A random sample of 696 control patients matched by age, sex, race, and hospital admission date were selected from a total of 5,322 potential matched control subjects. NVHAP was pathogen-negative in 98 cases (56.3%). Respiratory viruses were identified in 42 patients (24.1%), gram-negative bacteria were seen in 25 patients (14.4%), and gram-positive bacteria were identified in 20 patients (11.5%). Individuals in whom NVHAP developed were more likely to die (15.5% vs 1.6%; P < .01), to require intensive care (56.3% vs 22.8%; P < .01) or mechanical ventilation (19.0% vs 3.9%; P < 0.01), and to have a longer hospital length of stay (15.9 days [range, 9.8-26.3 days] vs 4.4 days [range, 2.9-7.3 days]; P < 0.01). This case-control study identified a strong association between hospital mortality and NVHAP, with patients who acquired NVHAP having an 8.4 times greater odds of death (95% CI, 5.6-12.5).
The occurrence of NVHAP was associated with significant increases in mortality, the use of intensive care and mechanical ventilation, and hospital length of stay. We also found that respiratory viruses were an important cause of NVHAP. These findings suggest that efforts aimed at the successful prevention of NVHAP could improve patient outcomes and reduce health-care costs.
非通气型医院获得性肺炎（NVHAP）是一种严重的医院感染，越来越多地归因于抗生素耐药菌。
这是一项回顾性病例对照研究，比较了2014年1月1日至2014年12月31日期间在密苏里州圣路易斯市一家拥有1300张床位的城市学术医疗中心巴恩斯-犹太医院患有和未患有NVHAP的患者。
连续纳入174例NVHAP患者。从总共5322名潜在匹配对照受试者中选取了696名按年龄、性别、种族和住院日期匹配的对照患者随机样本。98例（56.3%）NVHAP患者病原体检测为阴性。42例患者（24.1%）检测出呼吸道病毒，25例患者（14.4%）检测出革兰氏阴性菌，20例患者（11.5%）检测出革兰氏阳性菌。发生NVHAP的患者更有可能死亡（15.5%对1.6%；P <.01），需要重症监护（56.3%对22.8%；P <.01）或机械通气（19.0%对3.9%；P < 0.01），并且住院时间更长（15.9天[范围，9.8 - 26.3天]对4.4天[范围，2.9 - 7.3天]；P < 0.01）。这项病例对照研究确定了医院死亡率与NVHAP之间的密切关联，发生NVHAP的患者死亡几率高8.4倍（95%CI，5.6 - 12.5）。
NVHAP的发生与死亡率显著增加、重症监护和机械通气的使用以及住院时间延长有关。我们还发现呼吸道病毒是NVHAP的一个重要病因。这些发现表明，旨在成功预防NVHAP的努力可以改善患者预后并降低医疗成本。
