Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.
2nd Critical Care Department, Attikon University Hospital, Athens, Greece.
Eur J Clin Microbiol Infect Dis. 2017 Nov;36(11):1999-2006. doi: 10.1007/s10096-016-2703-z. Epub 2016 Jun 10.
We report on intensive care nosocomial pneumonia (NP) in Europe through a review of EU-VAP/CAP manuscripts: a prospective observational study, enrolling patients from 27 ICUs in nine European countries. From 2,436 eligible ICU patients, 827 cases presented NP, with 18.3 episodes of VAP per 1000 ventilator-days. Most common findings were worsening oxygenation, purulent respiratory secretions and temperature increase. At least three criteria from Clinical Pulmonary Infection score (CPIS) were present in 77.9 % of episodes, but only 0.2 % met six CPIS criteria. Diagnosis was confirmed mainly noninvasively (74.8 %), with half qualitative and quantitative cultures. The dominant isolate was S. aureus in Spain, France, Belgium and Ireland, P. aeruginosa in Italy and Portugal, Acinetobacter in Greece and Turkey, but Escherichia coli in Germany. NP resulted in 6 % higher mortality, longer ICU stay and duration of mechanical ventilation (12 and 10 days). COPD and age ≥45 years were not associated with higher VAP incidence but did correlate with increased mortality. Trauma had higher VAP incidence but lower mortality. Bacteremia (led by MRSA and Acinetobacter baumannii) was documented in 14.6 %, being associated with extra ICU stay and mortality. Vasopressors and ICUs with above 25 % prevalence of Potential Resistant Organisms (PRM) were independently associated with PRM, being documented in 50.7 % of patients with early-onset VAP without known risk factors. Most patients initially received combination therapy. Delay in appropriate antimicrobial choice significantly increased mortality, and LOS in survivors was six days longer (p < 0.05). In conclusion, NP management in Europe presents local differences and major shifts when compared to reports from North America, outcomes of randomized trials and general guidelines.
我们通过对欧盟重症监护室获得性肺炎（NP）的综述报告来了解欧洲 ICU 获得性肺炎的情况：这是一项前瞻性观察研究，纳入了来自欧洲 9 个国家 27 家 ICU 的患者。在 2436 名符合条件的 ICU 患者中，827 例患者发生 NP，每 1000 个机械通气日发生 18.3 例 VAP。最常见的表现为氧合恶化、脓性呼吸道分泌物和体温升高。77.9%的病例至少有 3 项临床肺部感染评分（CPIS）标准，但仅有 0.2%的病例符合 6 项 CPIS 标准。诊断主要通过非侵入性方法（74.8%）确定，采用半定量和定量培养。西班牙、法国、比利时和爱尔兰的优势分离株为金黄色葡萄球菌，意大利和葡萄牙为铜绿假单胞菌，希腊和土耳其为不动杆菌，但德国为大肠埃希菌。NP 导致死亡率增加 6%，ICU 住院时间和机械通气时间延长（12 天和 10 天）。COPD 和年龄≥45 岁与更高的 VAP 发生率无关，但与更高的死亡率相关。创伤患者的 VAP 发生率更高，但死亡率更低。血培养阳性（以耐甲氧西林金黄色葡萄球菌和鲍曼不动杆菌为主）率为 14.6%，与 ICU 住院时间延长和死亡率增加相关。血管加压素和 PRM 患病率超过 25%的 ICU 与 PRM 独立相关，在无明确危险因素的早发性 VAP 患者中，50.7%的患者存在 PRM。大多数患者最初接受联合治疗。延迟选择适当的抗菌药物显著增加死亡率，且存活者的 LOS 延长了 6 天（p<0.05）。总之，与北美、随机试验结果和一般指南相比，欧洲 NP 的管理存在地域差异和重大转变。
