Department of Respiratory and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, China.
Department of Surgery Intensive Care Unit, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
J Infect Public Health. 2019 Sep-Oct;12(5):630-633. doi: 10.1016/j.jiph.2019.02.014. Epub 2019 Feb 26.
Hospital-acquired pneumonia (HAP) remains an important cause of morbidity and mortality despite advances in antimicrobial therapy. The emergence of Gram-negative bacteria (GNB) is of major concern. The objective of this study was to describe the epidemiology, microbiology, and predictors of infection-related 30-day mortality in HAP with GNB.
We performed a retrospective, single-center analysis of HAP patients with GNB occurring from January 2014 and December 2017. Univariate and multivariate analyses were performed to identify the risk factors for mortality.
During the observational period, there were 1472 cases of HAP; 314 cases were bacterial culture-positive, 269 cases were caused by GNB, with a predominance of Acinetobacter baumannii and Pseudomonas aeruginosa. The mortality related to GNB was 14.5% (39 deaths).In the multivariate logistic regression analysis, the risk factors for mortality were age >70 years, intensive care unit (ICU) admission, blood lymphocyte count < 0.8 × 10/L, multidrug-resistant Gram-negative bacteria(MDR-GNB) infection, and elevation of blood urea nitrogen(BUN) level. We identified these factors as significant predictors of GNB related mortality; the area under the receiver operating characteristic (ROC) curves was 0.836.
The results provided can help clinicians in identifying individuals who are at risk of infection-related 30-day mortality in HAP with GNB.
尽管抗菌治疗取得了进展，但医院获得性肺炎（HAP）仍然是发病率和死亡率的重要原因。革兰氏阴性菌（GNB）的出现引起了极大的关注。本研究的目的是描述 GNB 引起的 HAP 的流行病学、微生物学和感染相关 30 天死亡率的预测因素。
我们对 2014 年 1 月至 2017 年 12 月期间发生的 GNB 引起的 HAP 患者进行了回顾性、单中心分析。进行了单因素和多因素分析，以确定与死亡率相关的危险因素。
在观察期间，有 1472 例 HAP 患者；314 例细菌培养阳性，269 例由 GNB 引起，以鲍曼不动杆菌和铜绿假单胞菌为主。与 GNB 相关的死亡率为 14.5%（39 例死亡）。多变量逻辑回归分析表明，死亡的危险因素是年龄>70 岁、入住重症监护病房（ICU）、血淋巴细胞计数<0.8×10/L、耐多药革兰氏阴性菌（MDR-GNB）感染和血尿素氮（BUN）水平升高。我们将这些因素确定为 GNB 相关死亡率的重要预测因素；接受者操作特征（ROC）曲线下的面积为 0.836。
这些结果可以帮助临床医生识别出患有 GNB 引起的 HAP 并与感染相关的 30 天死亡率相关的个体。
