Department of Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Division of Sleep Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
BMC Pulm Med. 2021 Jan 30;21(1):47. doi: 10.1186/s12890-021-01415-8.
Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patterns for early-onset VAP (EOVAP) and late-onset VAP (LOVAP) will help to choose appropriate empiric antibiotics.
To compare the multi-drug resistant (MDR) pathogens, treatment outcomes, and factors associated with hospital mortality of VAP.
A cross-sectional study between 1 January 2015 and 31 December 2017 at Srinagarind hospital, Khon Kaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed.
One hundred and ninety patients were enrolled; 42 patients (22%) were EOVAP and 148 patients (78%) were LOVAP. Acinetobacter baumannii was the most common pathogen in both groups (50% EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8%) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS [median (interquartile range, IQR) 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days], hospital LOS [median (IQR) 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days] shorter MV days [median (IQR) 14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days] and lower hospital mortality (16.7% vs 35.1%) than LOVAP (p < 0.05). The factor associated with hospital mortality was having simplified acute physiology (SAP) II score ≥ 40 with an adjusted odds ratio (aOR) of 2.22 [95% confidence interval (CI), 1.08-4.54, p = 0.02].
LOVAP had significantly higher MDR pathogens, MV days, ICU LOS, hospital LOS and hospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogens should be considered in LOVAP. The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）中常见的医院获得性感染。对早发性 VAP（EOVAP）和迟发性 VAP（LOVAP）的病原体和耐药模式进行局部微生物学监测，有助于选择合适的经验性抗生素。
比较 VAP 的多药耐药（MDR）病原体、治疗结果和与住院死亡率相关的因素。
2015 年 1 月 1 日至 2017 年 12 月 31 日，在泰国孔敬大学诗琳通医院进行了一项横断面研究。回顾性分析了人口统计学数据、病原体、住院时间（LOS）、重症监护室 LOS、机械通气（MV）天数和住院死亡率。
共纳入 190 例患者，其中 42 例（22%）为 EOVAP，148 例（78%）为 LOVAP。鲍曼不动杆菌在两组中均为最常见的病原体（EOVAP 为 50%，LOVAP 为 52.7%）。MDR 病原体在 LOVAP 中明显高于 EOVAP（81.8%比 61.9%）（p=0.007）。EOVAP 的 ICU LOS[中位数（四分位距，IQR）20.0（11.0，30.0）比 26.5（17.0，43.0）天]、医院 LOS[中位数（IQR）26.5（15.0，44.0）比 35.5（24.0，56.0）天]、MV 天数[中位数（IQR）14.0（10.0，29.0）比 23.0（14.0，35.5）天]和住院死亡率（16.7%比 35.1%）均明显低于 LOVAP（p<0.05）。与住院死亡率相关的因素是 SAP II 评分≥40，校正优势比（aOR）为 2.22[95%置信区间（CI），1.08-4.54，p=0.02]。
LOVAP 的 MDR 病原体、MV 天数、ICU LOS、医院 LOS 和住院死亡率明显高于 EOVAP。对于 LOVAP，应考虑使用广谱抗生素覆盖 MDR 病原体。VAP 住院死亡率的相关因素是 SAP II 评分≥40。
