Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 407, Taiwan.
Nursing Department, Taichung Veterans General Hospital, Taichung, 407, Taiwan.
Int J Chron Obstruct Pulmon Dis. 2021 Jun 17;16:1801-1811. doi: 10.2147/COPD.S311714. eCollection 2021.
Little is known about the features and implications of (PA) and complex (ABC) isolates discovered in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring invasive mechanical ventilation and admission to an intensive care unit. Thus, our study aimed to investigate the clinical characteristics and antimicrobial susceptibilities of PA and ABC isolates cultured from endotracheal aspirates (EAs) in such population.
In this retrospective, cross-sectional study, clinical data from medical records were reviewed and collected for analysis.
Of the 262 participants, 17.2% (45/262), 11.5% (30/262), and 27.1% (71/262) had PA, ABC, and any of the two isolates discovered from EA cultures, respectively. Patients with PA isolates were associated with poorer lung function (the Global Initiative for Chronic Obstructive Lung Disease (GOLD) III+IV versus GOLD I+II, odds ratio (OR)=2.39, p= 0.022) and a lower body mass index (per increase of 1 kg/m, OR= 0.93, p= 0.106) while the former was an independent predictor. Moreover, both subjects with ABC isolates and those with any of these two microorganisms were independently associated with a lower serum albumin level (per increase of 1 g/dL, OR= 0.44, p=0.009 and OR= 0.59, p=0.023, respectively). Participants with PA isolates were more likely to have failed weaning (62.2% versus 44.7%, p= 0.048) and death (28.9% versus 12.4%, p= 0.010) than those without PA isolates. The majority of the PA and ABC isolates were susceptible and resistant to all the tested antimicrobials, respectively, except that tigecycline had a reliable activity against ABC.
Our findings provide important information to help intensivists make better treatment decisions in critically ill patients with COPD and CAP.
对于慢性阻塞性肺疾病（COPD）和社区获得性肺炎（CAP）患者，需要进行有创机械通气并入住重症监护病房时分离出的 （PA）和 复杂（ABC）分离株的特征和影响，目前了解甚少。因此，我们的研究旨在调查从此类人群的气管内抽吸物（EA）中培养出的 PA 和 ABC 分离株的临床特征和抗菌药物敏感性。
在这项回顾性、横断面研究中，对病历中的临床数据进行了回顾和收集分析。
在 262 名参与者中，分别有 17.2%（45/262）、11.5%（30/262）和 27.1%（71/262）从 EA 培养物中发现了 PA、ABC 和两者中的任何一种分离株。PA 分离株患者的肺功能更差（全球慢性阻塞性肺疾病倡议（GOLD）III+IV 与 GOLD I+II，比值比（OR）=2.39，p=0.022），体重指数（BMI）较低（每增加 1kg/m，OR=0.93，p=0.106），而前者是独立的预测因素。此外，ABC 分离株患者和两种微生物中的任何一种患者的血清白蛋白水平均独立降低（每增加 1g/dL，OR=0.44，p=0.009 和 OR=0.59，p=0.023）。PA 分离株患者更容易发生撤机失败（62.2%比 44.7%，p=0.048）和死亡（28.9%比 12.4%，p=0.010）。大多数 PA 和 ABC 分离株对所有测试的抗菌药物均敏感和耐药，除替加环素对 ABC 具有可靠的活性外。
我们的研究结果为危重病 COPD 和 CAP 患者的重症监护医师提供了重要信息，以帮助他们做出更好的治疗决策。
