Uvizl Radovan, Kolar Milan, Herkel Tomas, Vobrova Michaela, Langova Katerina
Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2017 Sep;161(3):303-309. doi: 10.5507/bp.2017.019. Epub 2017 Apr 26.
Hospital-acquired pneumonia (HAP) development is affected by a range of risk factors.
A retrospective, observational study processing data on all consecutive intensive care patients older than 18 years of age between 1 January 2011 and 31 December 2015. The aim was to determine the incidence of potential risk factors and their impact on the development of HAP.
A total of 2229 patients. The overall mortality was 24.0%; the mean APACHE II score 21.4. The mean length of ICU stay was 5.9 days and the mean length of hospital stay was 20.5 days. The criteria for HAP were met by 310 patients (13.9%). Early- and late-onset HAP was diagnosed in 45 (14.5%) and 265 (85.5%) patients, respectively. The mean APACHE II score was 22.1, the mean length of ICU stay was 7.6 days and the mean length of hospital stay was 23.5 days. The most important non-modifiable factors increasing the risk of HAP were multiple organ failure (OR 13.733; P<0.0001), cardiac heart disease (OR 2.255; P<0.0001) and chronic renal failure (OR 2.194; P<0.002). The most common modifiable factors were intolerance to enteral nutrition (OR 3.055; P<0.0001), urgent tracheal intubation (OR 1.511; P<0.024), reintubation (OR 1.851; P<0.001), and bronchoscopy (OR 2.558; P<0.0001). Stress ulcer prophylaxis was administered to 83% of HAP patients and 68% of patients without HAP. Prophylaxis with famotidine was associated with a lower risk of HAP in 40.0% of patients (non-HAP in 49.9%), (OR 0.669; P=0.001) than prophylaxis with pentoprazol in 42.6% and 49.5% of patients, respectively (OR 0.756; P=0.027).
. Factors associated with the highest risk of the development of HAP can be determined. Pharmacological prophylaxis of gastric and duodenal stress ulcers was identified as an independent risk factor for HAP. The study was registered in the ClinicalTrials.gov database under the number NCT02779933.
医院获得性肺炎（HAP）的发生受一系列危险因素影响。
一项回顾性观察研究，处理2011年1月1日至2015年12月31日期间所有连续入住重症监护病房的18岁以上患者的数据。目的是确定潜在危险因素的发生率及其对HAP发生的影响。
共纳入2229例患者。总体死亡率为24.0%；急性生理与慢性健康状况评分系统（APACHE II）平均得分为21.4分。重症监护病房（ICU）平均住院时间为5.9天，医院平均住院时间为20.5天。310例患者（13.9%）符合HAP诊断标准。早发性和晚发性HAP分别在45例（14.5%）和265例（85.5%）患者中被诊断。APACHE II平均得分为22.1分，ICU平均住院时间为7.6天，医院平均住院时间为23.5天。增加HAP风险的最重要不可改变因素是多器官功能衰竭（比值比[OR]13.733；P<0.0001）、心脏病（OR 2.255；P<0.0001）和慢性肾衰竭（OR 2.194；P<0.002）。最常见的可改变因素是肠内营养不耐受（OR 3.055；P<0.0001）、紧急气管插管（OR 1.511；P<0.024）、再次插管（OR 1.851；P<0.001）和支气管镜检查（OR 2.558；P<0.0001）。83%的HAP患者和68%无HAP的患者接受了应激性溃疡预防治疗。在40.0%的患者中（49.9%无HAP），使用法莫替丁预防与较低的HAP风险相关（OR 0.669；P=0.001），而在42.6%和49.5%的患者中分别使用泮托拉唑预防（OR 0.756；P=0.027）。
可以确定与HAP发生风险最高相关的因素。胃和十二指肠应激性溃疡的药物预防被确定为HAP的独立危险因素。该研究已在ClinicalTrials.gov数据库注册，注册号为NCT02779933。
