呼吸机相关性气管支气管炎患者死亡的危险因素：一项病例对照研究。

Risk factors for mortality in ventilator-associated tracheobronchitis: a case-control study.

作者信息

Pontes Leonilda Giani, Menezes Fernando Gatti de, Gonçalves Priscila, Toniolo Alexandra do Rosário, Silva Claudia Vallone, Kawagoe Julia Yaeko, Santos Camila Marques Dos, Castagna Helena Maria Fernandes, Martino Marinês Dalla Valle, Corrêa Luci

机构信息

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

Universidade Federal de São Paulo, São Paulo, SP, Brazil.

出版信息

Einstein (Sao Paulo). 2017;15(1):61-64. doi: 10.1590/S1679-45082017AO3865.

DOI:10.1590/S1679-45082017AO3865

PMID:28444091

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5433309/

Abstract

OBJECTIVE

To describe the microbiological characteristics and to assess the risk factors for mortality of ventilator-associated tracheobronchitis in a case-control study of intensive care patients.

METHODS

This case-control study was conducted over a 6-year period in a 40-bed medical-surgical intensive care unit in a tertiary care, private hospital in São Paulo, Brazil. Case patients were identified using the Nosocomial Infection Control Committee database. For the analysis of risk factors, matched control subjects were selected from the same institution at a 1:8.8 ratio, between January 2006 and December 2011.

RESULTS

A total of 40 episodes of ventilator-associated tracheobronchitis were evaluated in 40 patients in the intensive care unit, and 354 intensive care patients who did not experience tracheobronchitis were included as the Control Group. During the 6-year study period, a total of 42 organisms were identified (polymicrobial infections were 5%) and 88.2% of all the microorganisms identified were Gram-negative. Using a logistic regression model, we found the following independent risk factors for mortality in ventilator-associated tracheobronchitis patients: Acute Physiology and Chronic Health Evaluation I score (odds ratio 1.18 per unit of score; 95%CI: 1.05-1.38; p=0.01), and duration of mechanical ventilation (odds ratio 1.09 per day of mechanical ventilation; 95%CI: 1.03-1.17; p=0.004).

CONCLUSION

Our study provided insight into the risk factors for mortality and microbiological characteristics of ventilator-associated tracheobronchitis.

摘要

目的

在一项针对重症监护患者的病例对照研究中，描述呼吸机相关性气管支气管炎的微生物学特征并评估其死亡风险因素。

方法

本病例对照研究在巴西圣保罗一家私立三级护理医院的一个拥有40张床位的内科-外科重症监护病房进行，为期6年。通过医院感染控制委员会数据库确定病例患者。为分析风险因素，在2006年1月至2011年12月期间，从同一机构按1:8.8的比例选取匹配的对照受试者。

结果

重症监护病房的40例患者共发生40次呼吸机相关性气管支气管炎发作，354例未发生气管支气管炎的重症监护患者被纳入对照组。在6年的研究期间，共鉴定出42种微生物（混合感染占5%），所有鉴定出的微生物中88.2%为革兰氏阴性菌。使用逻辑回归模型，我们发现呼吸机相关性气管支气管炎患者死亡的以下独立风险因素：急性生理与慢性健康状况评估I评分（每单位评分的比值比为1.18；95%置信区间：1.05-1.38；p=0.01），以及机械通气时间（每机械通气一天的比值比为1.09；95%置信区间：1.03-1.17；p=0.004）。