Narewski Erin R, Kim Victor, Marchetti Nathaniel, Jacobs Michael R, Criner Gerard J
Temple University Hospital, Division of Pulmonary and Critical Care Medicine, Philadelphia, Pennsylvania.
Chronic Obstr Pulm Dis. 2015;2(3):252-258. doi: 10.15326/jcopdf.2.3.2014.0147.
Although methicillin-resistant Staphylococcus aureus (MRSA) colonization is common in chronic obstructive pulmonary disease (COPD) patients, its effect on the course of COPD hospitalization remains unknown.
Records of 160 patients hospitalized at our institution January 1, 2008 to May 1, 2010 with acute exacerbations of COPD who were screened for MRSA were examined and outcomes from their hospitalizations were quantified.
Of the 160 patients, 33 (20.6%) were MRSA colonized on screening. These patients had similar demographics, spirometry, Charlson Indexes, and APACHE-II scores when compared to patients who were not MRSA colonized (n=127), but MRSA colonized patients had more hospitalizations within the 2 years prior to admission (2 [1-4.8] versus 1 [0-3], = 0.03). While hospitalized, MRSA colonized patients had a longer length of stay (9 [5.3-15.5] versus 5 [3-7.8] days, = 0.01) and more antibiotic days (7 [5-10.8] versus 5 [0-7] days, = 0.01). They were also more likely to receive intensive care (51.5% versus 23.6%, = 0.01) and to develop respiratory failure that required noninvasive ventilation (56.3% versus 38.2%, = 0.05). Trends towards increased use of invasive mechanical ventilation and readmission within 30 days were also present.
COPD patients colonized with MRSA have longer hospitalizations, require longer courses of antibiotics, and are more likely to require intensive care.
尽管耐甲氧西林金黄色葡萄球菌（MRSA）定植在慢性阻塞性肺疾病（COPD）患者中很常见，但其对COPD住院病程的影响仍不清楚。
对2008年1月1日至2010年5月1日在我院住院的160例因COPD急性加重而接受MRSA筛查的患者的记录进行检查，并对其住院结局进行量化。
160例患者中，33例（20.6%）在筛查时被MRSA定植。与未被MRSA定植的患者（n = 127）相比，这些患者的人口统计学特征、肺功能、查尔森指数和急性生理与慢性健康状况评分系统-II（APACHE-II）评分相似，但MRSA定植患者在入院前2年内的住院次数更多（2[1 - 4.8]次对1[0 - 3]次，P = 0.03）。住院期间，MRSA定植患者的住院时间更长（9[5.3 - 15.5]天对5[3 - 7.8]天，P = 0.01），使用抗生素的天数更多（7[5 - 10.8]天对5[0 - 7]天，P = 0.01）。他们也更有可能接受重症监护（51.5%对23.6%，P = 0.01），并发生需要无创通气的呼吸衰竭（56.3%对38.2%，P = 0.05）。在有创机械通气的使用增加和30天内再入院方面也存在趋势。
被MRSA定植的COPD患者住院时间更长，需要更长疗程的抗生素治疗，并且更有可能需要重症监护。
