Chiang Shyh-Ren, Lai Chih-Cheng, Ho Chung-Han, Chen Chin-Ming, Chao Chien-Ming, Wang Jhi-Joung, Cheng Kuo-Chen
Department of Internal Medicine, Chi Mei Medical Center, 71004 Tainan, Taiwan.
Department of General Education, Chia Nan University of Pharmacy and Science, 71710 Tainan, Taiwan.
J Clin Med. 2018 Aug 20;7(8):224. doi: 10.3390/jcm7080224.
Interactions between mechanical ventilation (MV) and carbapenem interventions were investigated for the risk of infection (CDI) in critically ill patients undergoing concurrent carbapenem therapy.
Taiwan's National Intensive Care Unit Database (NICUD) was used in this analytical, observational, and retrospective study. We analyzed 267,871 intubated patients in subgroups based on the duration of MV support: 7⁻14 days ( = 97,525), 15⁻21 days ( = 52,068), 22⁻28 days ( = 35,264), and 29⁻60 days ( = 70,021). The primary outcome was CDI.
Age (>75 years old), prolonged MV assistance (>21 days), carbapenem therapy (>15 days), and high comorbidity scores were identified as independent risk factors for developing CDI. CDI risk increased with longer MV support. The highest rate of CDI was in the MV 29⁻60 days subgroup (adjusted hazard ratio (AHR) = 2.85; 95% confidence interval (CI) = 1.46⁻5.58; < 0.02). Moreover, higher CDI rates correlated with the interaction between MV and carbapenem interventions; these CDI risks were increased in the MV 15⁻21 days (AHR = 2.58; 95% CI = 1.12⁻5.91) and MV 29⁻60 days (AHR = 4.63; 95% CI = 1.14⁻10.03) subgroups than in the non-MV and non-carbapenem subgroups.
Both MV support and carbapenem interventions significantly increase the risk that critically ill patients will develop CDI. Moreover, prolonged MV support and carbapenem therapy synergistically induce CDI. These findings provide new insights into the role of MV support in the development of CDI.
研究机械通气（MV）与碳青霉烯类药物干预措施之间的相互作用，以评估接受碳青霉烯类药物联合治疗的重症患者发生感染（艰难梭菌感染，CDI）的风险。
本分析性、观察性和回顾性研究使用了台湾地区国家重症监护病房数据库（NICUD）。我们根据MV支持的持续时间将267,871例插管患者分为亚组：7至14天（n = 97,525）、15至21天（n = 52,068）、22至28天（n = 35,264）和29至60天（n = 70,021）。主要结局为CDI。
年龄（>75岁）、延长的MV辅助时间（>21天）﹑碳青霉烯类药物治疗时间（>15天）和高合并症评分被确定为发生CDI的独立危险因素。CDI风险随MV支持时间延长而增加。CDI发生率最高的是MV 29至60天亚组（调整后风险比（AHR）= 2.85；95%置信区间（CI）= 1.46至5.58；P < 0.02）。此外，较高的CDI发生率与MV和碳青霉烯类药物干预措施之间的相互作用相关；与非MV和非碳青霉烯类药物亚组相比，MV 15至21天亚组（AHR = 2.58；95% CI = 1.12至5.91）和MV 29至60天亚组（AHR = 4.63；95% CI = 1.14至10.03）的这些CDI风险增加。
MV支持和碳青霉烯类药物干预措施均显著增加重症患者发生CDI的风险。此外，延长的MV支持和碳青霉烯类药物治疗协同诱导CDI。这些发现为MV支持在CDI发生中的作用提供了新的见解。
