多重耐药铜绿假单胞菌与机械通气 ICU 患者的死亡率。
Multidrug-resistant Pseudomonas aeruginosa and mortality in mechanically ventilated ICU patients.
机构信息
Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, Marseille, France.
Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, Marseille, France.
出版信息
Am J Infect Control. 2019 Sep;47(9):1059-1064. doi: 10.1016/j.ajic.2019.02.030. Epub 2019 Apr 6.
BACKGROUND
The link between bacterial resistance and prognosis remains controversial. Predominant pathogen causing ventilator-associated pneumonia (VAP) is Pseudomonas aeruginosa (Pa), which has increasingly become multidrug resistant (MDR). The aim of this study was to evaluate the relationship between MDR VAP Pa episodes and 30-day mortality.
METHODS
From a longitudinal prospective French multicenter database (2010-2016), Pa VAP onset and physiological data were recorded. MDR was defined as non-susceptibility to at least 1 agent in 3 or more antimicrobial categories. To analyze if MDR episodes were associated with greater in-hospital 30-day mortality, we performed a multivariate survival analysis using the multivariate nonlinear frailty model.
RESULTS
A total of 230 patients presented 286 Pa VAP. A maximum of 3 episodes per patient was observed; 73 episodes were MDR and 213 were susceptible. In the multivariate model, factors independently associated with 30-day mortality included hospitalization in the 6 months preceding the first episode (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.50-3.60; P = .0002), chronic renal failure (HR, 2.34; 95% CI, 1.15-4.77; P = .0196), and Pa VAP recurrence (HR, 2.29; 95% CI, 1.79-4.87; P = .032). Finally, MDR Pa VAP was not associated with death (HR, 0.87; 95% CI; 0.52-1.45; P = .59).
CONCLUSIONS
This study did not identify a relationship between the resistance profile of Pseudomonas aeruginosa and mortality.
背景
细菌耐药性与预后之间的联系仍存在争议。引起呼吸机相关性肺炎（VAP）的主要病原体是铜绿假单胞菌（Pa），它的耐药性越来越强，已经成为了多重耐药菌（MDR）。本研究旨在评估 MDR 铜绿假单胞菌 VAP 发作与 30 天死亡率之间的关系。
方法
从 2010 年至 2016 年法国的一项前瞻性纵向多中心数据库中，记录了铜绿假单胞菌 VAP 的发病和生理数据。MDR 定义为对至少 3 种抗菌药物类别的 1 种药物不敏感。为了分析 MDR 发作是否与更高的院内 30 天死亡率相关，我们使用多变量非线性脆弱性模型进行了多变量生存分析。
结果
共有 230 例患者出现 286 例铜绿假单胞菌 VAP。每个患者最多观察到 3 个发作；73 个发作是 MDR，213 个是敏感的。在多变量模型中，与 30 天死亡率独立相关的因素包括首次发作前 6 个月内的住院治疗（风险比[HR]，2.31；95%置信区间[CI]，1.50-3.60；P=0.0002）、慢性肾功能衰竭（HR，2.34；95%CI，1.15-4.77；P=0.0196）和铜绿假单胞菌 VAP 复发（HR，2.29；95%CI，1.79-4.87；P=0.032）。最后，MDR 铜绿假单胞菌 VAP 与死亡无关（HR，0.87；95%CI，0.52-1.45；P=0.59）。
结论
本研究未发现铜绿假单胞菌耐药谱与死亡率之间存在关系。
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