Udompat Patpong, Rongmuang Daravan, Hershow Ronald Craig
Department of Social Medicine, Prapokklao Hospital, Chanthaburi, Thailand.
Department of Adult and Elderly Nursing, Prapokklao Nursing College, Chanthaburi, Thailand .
J Infect Dev Ctries. 2021 Oct 31;15(10):1471-1480. doi: 10.3855/jidc.14190.
Ventilator-associated pneumonia patients are treated in non-intensive care units because of a shortage of intensive care unit beds in Thailand. Our objective was to assess whether the type of unit and medications prescribed to the patient were associated with ventilator‑associated pneumonia and multidrug resistant ventilator‑associated pneumonia.
A matched case-control study nested in a prospective cohort of mechanical ventilation adult patients in a medical-surgical intensive care unit and five non-intensive care units from March 1 through October 31, 2013. The controls were randomly selected 1:1 with cases and matched based on duration and start date of mechanical ventilation.
248 ventilator-associated pneumonia and control patients were analyzed. The most common bacteria were multidrug resistant Acinetobacter baumannii (82.4%). Compared with patients in the intensive care unit, those in the neurosurgical/surgical non-intensive care units were at higher risk (p = 0.278). Proton pump inhibitor was a risk factor (p = 0.011), but antibiotic was a protective factor (p = 0.054). Broad spectrum antibiotic was a risk factor (p < 0.001) for multidrug resistant ventilator-associated pneumonia.
Post-surgical and neurosurgical patients treated in non-intensive care unit settings were at the highest risk of ventilator-associated pneumonia. Our findings suggest that alternative using proton pump inhibitors should be considered based on the risk-benefit of using this medication. In addition, careful stewardship of antibiotic use should be warranted to prevent multidrug resistant ventilator-associated pneumonia.
由于泰国重症监护病房床位短缺，呼吸机相关性肺炎患者在非重症监护病房接受治疗。我们的目的是评估患者所在病房类型和所使用的药物是否与呼吸机相关性肺炎及多重耐药呼吸机相关性肺炎有关。
一项匹配病例对照研究嵌套于2013年3月1日至10月31日期间在一所内科-外科重症监护病房和五个非重症监护病房接受机械通气的成年患者前瞻性队列研究中。对照组按1:1比例与病例随机选取，并根据机械通气持续时间和开始日期进行匹配。
对248例呼吸机相关性肺炎患者和对照患者进行了分析。最常见的细菌是多重耐药鲍曼不动杆菌（82.4%）。与重症监护病房的患者相比，神经外科/外科非重症监护病房的患者风险更高（p = 0.278）。质子泵抑制剂是一个风险因素（p = 0.011），但抗生素是一个保护因素（p = 0.054）。广谱抗生素是多重耐药呼吸机相关性肺炎的一个风险因素（p < 0.001）。
在非重症监护病房接受治疗的外科和神经外科患者发生呼吸机相关性肺炎的风险最高。我们研究结果表明，应根据使用该药物的风险效益考虑替代使用质子泵抑制剂。此外，应谨慎管理抗生素的使用以预防多重耐药呼吸机相关性肺炎。
