Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom.
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
Am J Respir Crit Care Med. 2020 Oct 15;202(8):1125-1132. doi: 10.1164/rccm.202002-0355OC.
infection in patients with suspected ventilator-associated pneumonia remains uncharacterized because of the absence of a disease definition and limited access to sensitive diagnostic tests. To estimate the prevalence and outcomes of infection in adults with suspected ventilator-associated pneumonia. Two prospective UK studies recruited 360 critically ill adults with new or worsening alveolar shadowing on chest X-ray and clinical/hematological parameters supporting suspected ventilator-associated pneumonia. Stored serum and BAL fluid were available from 194 nonneutropenic patients and underwent mycological testing. Patients were categorized as having probable infection using a definition comprising clinical, radiological, and mycological criteria. Mycological criteria included positive histology or microscopy, positive BAL fluid culture, galactomannan optical index of 1 or more in BAL fluid or 0.5 or more in serum. Of 194 patients evaluated, 24 met the definition of probable infection, giving an estimated prevalence of 12.4% (95% confidence interval, 8.1-17.8). All 24 patients had positive galactomannan in serum ( = 4), BAL fluid ( = 16), or both ( = 4); three patients cultured sp. in BAL fluid. Patients with probable infection had a significantly longer median duration of critical care stay (25.5 vs. 15.5 d, = 0.02). ICU mortality was numerically higher in this group, although this was not statistically significant (33.3% vs. 22.8%; = 0.23). The estimated prevalence for probable infection in this geographically dispersed multicenter UK cohort indicates that this condition should be considered when investigating patients with suspected ventilator-associated pneumonia, including patient groups not previously recognized to be at high risk of aspergillosis.
由于缺乏疾病定义和有限的敏感诊断测试，疑似呼吸机相关性肺炎患者的感染情况仍不明确。本研究旨在评估疑似呼吸机相关性肺炎成人患者中 感染的患病率和结局。两项前瞻性英国研究纳入了 360 例新出现或加重的肺泡阴影、胸部 X 线和临床/血液学参数支持疑似呼吸机相关性肺炎的危重症成人患者。194 例非中性粒细胞减少患者的储存血清和 BAL 液可用于进行真菌学检测。采用包含临床、影像学和真菌学标准的定义，将患者分为可能患有 感染。真菌学标准包括组织学或显微镜阳性、BAL 液培养阳性、BAL 液中半乳甘露聚糖光学指数≥1 或血清中≥0.5。在评估的 194 例患者中，24 例符合可能患有 感染的定义，估计患病率为 12.4%（95%置信区间，8.1-17.8）。24 例患者的血清（ = 4）、BAL 液（ = 16）或两者（ = 4）中半乳甘露聚糖均为阳性；3 例患者 BAL 液中培养出 曲霉菌。可能患有 感染的患者的 ICU 中位留观时间显著延长（25.5 天比 15.5 天， = 0.02）。尽管这在统计学上无显著意义，但该组 ICU 死亡率更高（33.3%比 22.8%， = 0.23）。该地理分布广泛的英国多中心队列中，可能患有 感染的估计患病率表明，在调查疑似呼吸机相关性肺炎患者时，应考虑这种情况，包括以前未被认为有高侵袭性曲霉菌病风险的患者群体。
